pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_a_platino_flag	pbp_a_contract_partd_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_snp_pct	pbp_a_snp_pop	pbp_a_snp_cond	pbp_a_snp_state_cvg_yn	pbp_a_opd_web_addr	pbp_a_formulary_web_addr	pbp_a_pharmacy_website	pbp_a_curmbr_phone	pbp_a_curmbr_phone_ext	pbp_a_curmbr_loc_phone	pbp_a_curmbr_loc_phone_ext	pbp_a_prombr_phone	pbp_a_prombr_phone_ext	pbp_a_prombr_loc_phone	pbp_a_prombr_loc_phone_ext	pbp_a_pd_curmbr_phone	pbp_a_pd_curmbr_phone_ext	pbp_a_pd_curmbr_loc_phone	pbp_a_pd_curmbr_loc_phone_ext	pbp_a_pd_prombr_phone	pbp_a_pd_prombr_phone_ext	pbp_a_pd_prombr_loc_phone	pbp_a_pd_prombr_loc_phone_ext	pbp_a_ttytdd_curmbr_phone	pbp_a_ttytdd_curmbr_phone_ext	pbp_a_ttytdd_cur_loc_phone	pbp_a_ttytdd_cur_loc_phone_ext	pbp_a_ttytdd_prombr_phone	pbp_a_ttytdd_prombr_phone_ext	pbp_a_ttytdd_pro_loc_phone	pbp_a_ttytdd_pro_loc_phone_ext	pbp_a_pd_ttytdd_curmbr_phone	pbp_a_pd_ttytdd_curmbr_phn_ext	pbp_a_pd_ttytdd_cur_loc_phone	pbp_a_pd_ttytdd_cur_loc_phn_ex	pbp_a_pd_ttytdd_prombr_phone	pbp_a_pd_ttytdd_prombr_phn_ext	pbp_a_pd_ttytdd_pro_loc_phone	pbp_a_pd_ttytdd_pro_loc_phn_ex	pbp_a_ffs_bid_b_yn	pbp_a_ffs_bid_b_auth_yn	pbp_a_ffs_bid_b_auth_cats	pbp_a_ffs_bid_b_ref_yn	pbp_a_ffs_bid_b_ref_cats	pbp_a_ffs_bid_c_yn	pbp_a_ffs_bid_c_auth_yn	pbp_a_ffs_bid_c_auth_cats	pbp_a_ffs_bid_c_ref_yn	pbp_a_ffs_bid_c_ref_cats	pbp_a_ffs_bid_d_yn	pbp_a_tier_yn	pbp_a_tier_bendesc_bens	pbp_a_tier_mc_bendesc_cats	pbp_a_tier_nmc_bendesc_cats
E0654	801	0		30	13	E0654_801_0	1		1	06/01/2015	2016.01	06/01/2015 02:36:37 PM Eastern Daylight Time					06/01/2015 02:40:32 PM Eastern Daylight Time	IBT VOLUNTARY EMPLOYEE BENEFITS TRUST	TEAMStar Medicare Part D Prescription Drug Program	www.teamstarpartd.com	IBT Voluntary Employee Benefits Trust (Employer PDP)	13	30					E0654	801	0	2016	National		1					2								www.teamstarpartd.com	www.Optum.com									(866)524-4173		(866)524-4173		(866)524-4173		(866)524-4173										(866)524-4174		(866)524-4174		(866)524-4174		(866)524-4174																
E2630	801	0		30	13	E2630_801_0	1		1	05/20/2015	2016.01	05/20/2015 03:35:32 PM Eastern Daylight Time					05/20/2015 03:35:44 PM Eastern Daylight Time	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	C and O Employees Hospital Association	www.coeha.com	C and O Employees Hospital Association (Employer PDP)	13	30					E2630	801	0	2016	Virginia, West VA, Kentucky, Ohio, Indiana		1					2								http://www.coeha.com	http://www.navitus.com									(800)679-9135		(540)862-5728		(800)679-9135		(540)862-5728										(711)000-0000		(711)000-0000		(711)000-0000		(711)000-0000																
E3014	801	0		30	13	E3014_801_0	3		1	05/12/2015	2016.01	05/12/2015 10:51:47 AM Eastern Daylight Time					05/29/2015 04:58:47 PM Eastern Daylight Time	PSERS HOP PROGRAM	Pennsylvania Public School Employees Retirement Sy	http://www.psers.state.pa.us/hop/hop.htm	PSERS HOP (Employer PDP)	13	30					E3014	801	0	2016	National		1					2								http://www.hopbenefits.com/medicareRx/drugData/	http://www.hopbenefits.com/medicareRx/index.cfm?fa=findPharmacy									(888)239-1301		(888)239-1301		(800)773-7725		(800)773-7725										(800)498-5428		(800)498-5428		(800)498-5428		(800)498-5428																
E4744	801	0		30	13	E4744_801_0	1		1	05/19/2015	2016.01	05/19/2015 12:14:49 PM Eastern Daylight Time					05/19/2015 12:15:26 PM Eastern Daylight Time	MODOT/MSHP MEDICAL AND LIFE INSURANCE PLAN	MISSOURI DEPARTMENT OF TRANSPORTATION	http://www.modot.org/newsandinfo/GeneralInfo.htm	Missouri Department of Transportaion/ Highway Patr (Employer PDP)	13	30					E4744	801	0	2016	National		1					2								http://www.modot.org/newsandinfo/GeneralInfo/documents/Formulary.htm	https://mp.medimpact.com/pharmacyportal/public/Login.jsp									(800)601-3002		(573)751-2551		(800)601-3002		(573)751-2551										(800)221-6915		(573)221-6915		(800)221-6915		(800)221-6915																
E7316	801	0		30	13	E7316_801_0	4		1	05/12/2015	2016.01	05/12/2015 10:43:27 AM Eastern Daylight Time					06/01/2015 03:14:25 PM Eastern Daylight Time	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	Union Pacific Railroad  Employes Health Systems	www.uphealth.com	The UPREHS Prime Medicare Plan (Employer PDP)	13	30					E7316	801	0	2016	National Including Puerto Rico		1					2								www.uphealth.com	www.uphealth.com									(800)547-0421		(801)595-4300		(800)547-0421		(801)595-4300										(711)000-0000		(711)000-0000		(711)000-0000		(711)000-0000																
H0022	001	0	1	48	05	H0022_001_0	6		1	08/14/2015	2016.01	08/14/2015 10:50:56 AM Central Daylight Time					08/14/2015 03:31:23 PM Central Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Buckeye Health Plan - MyCare Ohio	http://mmp.buckeyehealthplan.com	Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H0022	001	0	2016	Cleveland, Dayton, Toledo and surrounding counties		2	12000	2			2							http://mmp.buckeyehealthplan.com/home/provider-directory/	http://mmp.buckeyehealthplan.com/home/prescription-drug-part-d-benefit-information/formulary/	http://mmp.buckeyehealthplan.com/home/provider-directory/	(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)-		2					2					2				
H0028	001	0	1	01	01	H0028_001_0	3		1	08/03/2015	2016.01	08/03/2015 12:40:34 PM Eastern Daylight Time	08/04/2015 10:58:35 AM Eastern Daylight Time	07/29/2015 08:44:14 PM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Gold Plus H0028-001 (HMO)	01	01		1			H0028	001	0	2016	Select counties in IA, NE, SD		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	004	0	1	01	01	H0028_004_0	3		1	07/08/2015	2016.01	07/08/2015 11:50:56 AM Eastern Daylight Time	08/03/2015 05:22:53 PM Eastern Daylight Time	07/30/2015 11:19:20 AM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Gold Plus H0028-004 (HMO)	01	01		1			H0028	004	0	2016	Honolulu, Kauai and Maui counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	1		1	05/11/2015	2016.01	05/11/2015 01:25:43 PM Eastern Daylight Time	05/29/2015 08:24:33 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H0028	801	0	2016	Select Counties in Iowa, South Dakota and Hawaii		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0028	802	0	1	01	01	H0028_802_0	1		1	05/11/2015	2016.01	05/11/2015 01:53:07 PM Eastern Daylight Time	05/29/2015 08:25:01 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H0028	802	0	2016	Select Counties in Iowa, South Dakota and Hawaii		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0104	012	0	1	04	01	H0104_012_0	3		1	07/31/2015	2016.01	07/31/2015 01:04:22 PM Central Daylight Time	07/30/2015 09:44:22 AM Central Daylight Time	07/30/2015 09:43:51 AM Central Daylight Time			07/31/2015 01:10:31 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	012	0	2016	H0104 Plan 012		2	22473	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(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	013	0	1	04	01	H0104_013_0	3		1	07/31/2015	2016.01	07/31/2015 01:04:32 PM Central Daylight Time	07/30/2015 09:43:37 AM Central Daylight Time	07/30/2015 09:44:30 AM Central Daylight Time			07/31/2015 01:10:31 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	013	0	2016	H0104 Plan 013		2	1609	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(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	3		1	07/31/2015	2016.01	07/31/2015 01:04:42 PM Central Daylight Time	07/30/2015 09:46:12 AM Central Daylight Time	07/30/2015 09:45:54 AM Central Daylight Time			07/31/2015 01:10:31 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	014	0	2016	H0104 Plan 014		2	23356	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(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	4		1	06/30/2015	2016.01	06/30/2015 12:56:27 PM Central Daylight Time	07/30/2015 09:45:34 AM Central Daylight Time	07/30/2015 09:46:26 AM Central Daylight Time			07/31/2015 01:21:23 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Premier (PPO)	01	04		1			H0104	015	0	2016	H0104 Plan 015		2	7074	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(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	05/29/2015	2016.01	05/29/2015 02:21:36 PM Central Daylight Time	06/01/2015 03:23:44 PM Central Daylight Time				06/01/2015 04:11:55 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 801 (PPO)	01	04		1			H0104	801	0	2016	State of Alabama		1	100	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H0104	802	0	1	04	01	H0104_802_0	1		1	05/21/2015	2016.01	05/21/2015 02:55:04 PM Central Daylight Time	06/01/2015 03:23:45 PM Central Daylight Time				06/01/2015 04:19:01 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 802 (PPO)	01	04		1			H0104	802	0	2016	State of Alabama		1	100	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(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						2			
H0104	804	0	1	04	01	H0104_804_0	1		1	05/21/2015	2016.01	05/21/2015 02:58:14 PM Central Daylight Time	06/01/2015 03:23:44 PM Central Daylight Time				06/01/2015 04:11:55 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 804 (PPO)	01	04		1			H0104	804	0	2016	State of Alabama		1	100	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(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						2			
H0105	001	0	1	20	08	H0105_001_0	1		1	05/18/2015	2016.01	05/18/2015 10:47:47 AM Eastern Daylight Time		05/18/2015 11:13:00 AM Eastern Daylight Time			05/19/2015 02:16:02 PM Eastern Daylight Time	THE METHODIST OAKS	The Methodist Oaks d.b.a. The Oaks PACE	http://www.theoakspace.com	The Methodist Oaks d.b.a. The Oaks PACE (PACE)	08	20		1			H0105	001	0	2016	Rural South Carolina		2		2			2							http://www.theoakspace.com	www.groveparkpharmacy.com	http://www.theoakspace.com									(855)268-5300		(803)268-5300		(855)268-5300		(803)268-5300										(855)268-5300		(803)535-1561		(855)268-5300		(803)268-5300																
H0105	002	0	1	20	08	H0105_002_0	1		1	05/18/2015	2016.01	05/18/2015 10:48:33 AM Eastern Daylight Time		05/18/2015 11:13:00 AM Eastern Daylight Time			05/19/2015 02:16:02 PM Eastern Daylight Time	THE METHODIST OAKS	The Methodist Oaks d.b.a. The Oaks PACE	http://www.theoakspace.com	The Methodist Oaks d.b.a. The Oaks PACE (PACE)	08	20		1			H0105	002	0	2016	Rural South Carolina		2		2			2							http://www.theoakspace.com	www.groveparkpharmacy.com	http://www.theoakspace.com									(855)268-5300		(803)268-5300		(855)268-5300		(803)268-5300										(855)268-5300		(803)535-1561		(855)268-5300		(803)268-5300																
H0107	001	0	1	04	01	H0107_001_0	10		1	08/03/2015	2016.01	08/03/2015 02:47:28 PM Central Daylight Time	08/03/2015 03:23:48 PM Central Daylight Time	08/03/2015 02:22:16 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.mybluemedicaremt.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H0107	001	0	2016	Montana		2	611	2			2							www.mybluemedicaremt.com	www.mybluemedicaremt.com	www.mybluemedicaremt.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	002	0	1	04	01	H0107_002_0	10		1	07/15/2015	2016.01	07/15/2015 04:27:12 PM Central Daylight Time	08/03/2015 03:24:22 PM Central Daylight Time	08/03/2015 02:23:46 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.mybluemedicaremt.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H0107	002	0	2016	Montana		2	152	2			2							www.mybluemedicaremt.com	www.mybluemedicaremt.com	www.mybluemedicaremt.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0107	801	0	1	04	01	H0107_801_0	5		1	05/20/2015	2016.01	05/20/2015 04:35:54 PM Central Daylight Time	05/31/2015 02:11:23 PM Central Daylight Time				05/31/2015 03:09:08 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.mybluemedicaremt.com	Blue Cross Medicare Advantage Employer Ideal (PPO)	01	04		1			H0107	801	0	2016	Montana		1	4719	2			2							www.mybluemedicaremt.com	www.mybluemedicaremt.com	www.mybluemedicaremt.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H0107	802	0	1	04	01	H0107_802_0	5		1	05/20/2015	2016.01	05/21/2015 02:57:46 PM Central Daylight Time	05/31/2015 02:12:00 PM Central Daylight Time				05/31/2015 03:09:08 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.mybluemedicaremt.com	Blue Cross Medicare Advantage Employer Expanded (PPO)	01	04		1			H0107	802	0	2016	Montana		1	4719	2			2							www.mybluemedicaremt.com	www.mybluemedicaremt.com	www.mybluemedicaremt.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H0112	001	0	1	20	08	H0112_001_0	1		1	05/20/2015	2016.01	05/20/2015 01:07:16 PM Eastern Daylight Time		05/20/2015 01:03:59 PM Eastern Daylight Time			05/20/2015 01:08:50 PM Eastern Daylight Time	MORSE LIFE HOME CARE, INC.	Palm Beach PACE	www.MorseLife.org	Palm Beach PACE (PACE)	08	20		1			H0112	001	0	2016	Palm Beach County (partial)		2		2			2								N/A	MorseLife.org									(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	05/20/2015	2016.01	05/20/2015 01:07:26 PM Eastern Daylight Time		05/20/2015 01:03:59 PM Eastern Daylight Time			05/20/2015 01:08:50 PM Eastern Daylight Time	MORSE LIFE HOME CARE, INC.	Palm Beach PACE	www.MorseLife.org	Palm Beach PACE (PACE)	08	20		1			H0112	002	0	2016	Palm Beach County (partial)		2		2			2								N/A	MorseLife.org									(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	4		1	07/17/2015	2016.01	07/17/2015 11:42:39 AM Eastern Daylight Time					07/17/2015 11:45:21 AM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance, Inc.	www.commonwealthonecare.org	Commonwealth Care Alliance (Medicare-Medicaid Plan)	05	48		1			H0137	001	0	2016	ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR.		2	11354	2			2							www.commonwealthcare.org	www.commonwealthonecare.org/pharmacy-program/formulary	www.commonwealthonecare.org/pharmacy-program/overview	(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H0141	004	1	1	01	01	H0141_004_1	3		1	05/31/2015	2016.01	05/31/2015 11:10:42 AM Eastern Daylight Time	08/04/2015 12:13:12 PM Eastern Daylight Time	08/04/2015 12:08:12 PM Eastern Daylight Time			08/05/2015 03:22:43 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Advantage	www.mclarenadvantage.org	McLaren Advantage Diamond (HMO)	01	01		1			H0141	004	1	2016	40 Counties in Michigan	Counties: BA, CB, CN, EM, GE, IN, IB, LP, MB, OK	2	637	2			2							www.mclarenadvantage.org	www.mclarenadvantage.org	www.mclarenadvantage.org	(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0141	004	2	1	01	01	H0141_004_2	3		1	05/31/2015	2016.01	05/31/2015 11:11:53 AM Eastern Daylight Time	08/04/2015 12:12:32 PM Eastern Daylight Time	08/04/2015 12:08:28 PM Eastern Daylight Time			08/05/2015 03:22:43 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Advantage	www.mclarenadvantage.org	McLaren Advantage Diamond (HMO)	01	01		1			H0141	004	2	2016	40 Counties in Michigan	Counties EXCEPT: BA,CB,CN,EM,GE,IN,IB,LP,MB,OK	2	37	2			2							www.mclarenadvantage.org	www.mclarenadvantage.org	www.mclarenadvantage.org	(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0141	005	1	1	01	01	H0141_005_1	4		1	05/27/2015	2016.01	05/27/2015 03:18:08 PM Eastern Daylight Time	08/04/2015 12:13:00 PM Eastern Daylight Time	08/04/2015 12:08:40 PM Eastern Daylight Time			08/05/2015 03:22:43 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Advantage	www.mclarenadvantage.org	McLaren Advantage Sapphire (HMO)	01	01		1			H0141	005	1	2016	40 Counties in Michigan	Counties: BA, CB, CN, EM, GE, IN, IB, LP, MB, OK	2	147	2			2							www.mclarenadvantage.org	www.mclarenadvantage.org	www.mclarenadvantage.org	(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0141	005	3	1	01	01	H0141_005_3	4		1	05/27/2015	2016.01	05/27/2015 03:21:18 PM Eastern Daylight Time	08/04/2015 12:12:44 PM Eastern Daylight Time	08/04/2015 12:08:52 PM Eastern Daylight Time			08/05/2015 03:22:43 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLaren Advantage	www.mclarenadvantage.org	McLaren Advantage Sapphire (HMO)	01	01		1			H0141	005	3	2016	40 Counties in Michigan	Counties EXCEPT: BA,CB,CN,EM,GE,IN,IB,LP,MB,OK	2	7	2			2							www.mclarenadvantage.org	www.mclarenadvantage.org	www.mclarenadvantage.org	(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0147	001	0	1	48	05	H0147_001_0	7		1	08/13/2015	2016.01	08/13/2015 08:24:06 PM Eastern Daylight Time					08/13/2015 08:38:09 PM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	mss.anthem.com/ccc	HealthKeepers (Medicare-Medicaid Plan)	05	48		1			H0147	001	0	2016	HealthKeepers Medicare-Medicaid Plan		2	500	2			2								mss.anthem.com/ccc	www.anthem.com	(855)817-5787		(855)817-5787		(855)817-5787		(855)817-5787		(855)817-5787		(855)817-5787		(855)817-5787		(855)817-5787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H0148	001	0	1	48	05	H0148_001_0	2		1	06/23/2015	2016.01	06/23/2015 09:49:33 AM Pacific Daylight Time					06/23/2015 09:58:53 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1st.com/ca/	Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H0148	001	0	2016	Care1st Health Plan San Diego County		2	4000	2			2							www.care1st.com/ca/	www.care1st.com/ca/	www.care1st.com/ca/	(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H0148	002	0	1	48	05	H0148_002_0	2		1	06/23/2015	2016.01	06/23/2015 09:49:46 AM Pacific Daylight Time					06/23/2015 10:08:44 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1st.com/ca/	Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H0148	002	0	2016	Care1st Health Plan Los Angeles County		2	7500	2			2							www.care1st.com/ca/	www.care1st.com/ca/	www.care1st.com/ca/	(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H0150	007	0	1	01	01	H0150_007_0	4	2	1	07/31/2015	2016.01	07/31/2015 08:50:26 AM Central Daylight Time	08/01/2015 09:43:48 AM Central Daylight Time	07/30/2015 08:04:55 AM Central Daylight Time			08/03/2015 03:57:29 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H0150	007	0	2016	Alabama		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0150	012	0	1	01	01	H0150_012_0	3		1	07/15/2015	2016.01	07/15/2015 10:49:41 AM Central Daylight Time	07/13/2015 05:06:37 PM Central Daylight Time				07/16/2015 09:50:25 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H0150	012	0	2016	Alabama		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0150	024	1	1	01	01	H0150_024_1	4		1	07/14/2015	2016.01	07/14/2015 03:52:56 PM Central Daylight Time	08/01/2015 09:44:18 AM Central Daylight Time	07/30/2015 08:05:23 AM Central Daylight Time			08/03/2015 03:57:29 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0150	024	1	2016	Alabama	Alabama Preferred	2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0150	024	2	1	01	01	H0150_024_2	4		1	07/14/2015	2016.01	07/14/2015 03:53:31 PM Central Daylight Time	08/01/2015 09:44:47 AM Central Daylight Time	07/30/2015 08:05:50 AM Central Daylight Time			08/03/2015 03:57:29 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0150	024	2	2016	Alabama	Alabama Preferred Select Counties	2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0150	025	0	1	02	01	H0150_025_0	5		1	07/14/2015	2016.01	07/14/2015 03:54:04 PM Central Daylight Time	08/01/2015 09:45:17 AM Central Daylight Time	07/30/2015 08:06:18 AM Central Daylight Time			08/03/2015 03:57:29 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H0150	025	0	2016	Alabama		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0150	804	0	1	01	01	H0150_804_0	4		1	05/21/2015	2016.01	05/21/2015 08:55:39 PM Central Daylight Time	07/13/2015 04:29:59 PM Central Daylight Time				07/16/2015 09:50:25 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H0150	804	0	2016	Alabama		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H0150	808	0	1	02	01	H0150_808_0	3		1	05/21/2015	2016.01	05/21/2015 08:59:02 PM Central Daylight Time	07/13/2015 04:30:35 PM Central Daylight Time				07/16/2015 09:50:25 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H0150	808	0	2016	Alabama		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H0150	809	0	1	01	01	H0150_809_0	3		1	05/21/2015	2016.01	05/21/2015 08:59:48 PM Central Daylight Time	07/13/2015 04:31:07 PM Central Daylight Time				07/16/2015 09:50:25 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H0150	809	0	2016	Alabama		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H0150	810	0	1	01	01	H0150_810_0	3		1	05/21/2015	2016.01	05/21/2015 09:00:24 PM Central Daylight Time	07/13/2015 04:31:37 PM Central Daylight Time				07/16/2015 09:50:25 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H0150	810	0	2016	Alabama		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H0150	811	0	1	02	01	H0150_811_0	3		1	05/21/2015	2016.01	05/21/2015 09:00:49 PM Central Daylight Time	07/13/2015 04:32:07 PM Central Daylight Time				07/16/2015 09:50:25 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H0150	811	0	2016	Alabama		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H0150	812	0	1	02	01	H0150_812_0	3		1	05/21/2015	2016.01	05/21/2015 09:01:17 PM Central Daylight Time	07/13/2015 04:32:37 PM Central Daylight Time				07/16/2015 09:50:25 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H0150	812	0	2016	Alabama		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H0151	001	0	1	01	01	H0151_001_0	2		1	07/31/2015	2016.01	07/31/2015 11:57:37 AM Central Daylight Time	07/31/2015 12:42:16 PM Central Daylight Time	07/30/2015 06:21:37 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0151	001	0	2016	Select counties in Alabama		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0151	015	0	1	01	01	H0151_015_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:16:18 AM Central Daylight Time	07/31/2015 12:42:40 PM Central Daylight Time	07/30/2015 06:22:33 AM Central Daylight Time			08/03/2015 02:29:08 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0151	015	0	2016	Select counties in Alabama		2		2			1	3		1	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	2			
H0151	025	0	1	01	01	H0151_025_0	3		1	07/31/2015	2016.01	07/31/2015 11:58:40 AM Central Daylight Time	07/31/2015 12:43:05 PM Central Daylight Time	07/30/2015 06:23:21 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H0151	025	0	2016	Select counties in Alabama		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0151	027	0	1	01	01	H0151_027_0	3		1	07/31/2015	2016.01	07/31/2015 11:59:38 AM Central Daylight Time	07/31/2015 12:43:30 PM Central Daylight Time	07/30/2015 06:24:06 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H0151	027	0	2016	Select counties in Alabama		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0151	801	0	1	01	01	H0151_801_0	1		1	04/13/2015	2016.01	04/13/2015 10:34:32 AM Central Daylight Time	05/29/2015 02:43:05 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0151	801	0	2016	Select Counties in Alabama		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H0151	804	0	1	01	01	H0151_804_0	1		1	04/13/2015	2016.01	04/13/2015 10:34:43 AM Central Daylight Time	05/29/2015 02:43:30 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0151	804	0	2016	Select Counties in Alabama		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H0151	805	0	1	01	01	H0151_805_0	1		1	04/13/2015	2016.01	04/13/2015 10:34:55 AM Central Daylight Time	05/29/2015 02:43:54 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0151	805	0	2016	Select Counties in Alabama		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H0154	008	0	1	01	01	H0154_008_0	4		1	07/06/2015	2016.01	07/06/2015 07:24:32 AM Central Daylight Time	07/20/2015 12:22:34 PM Central Daylight Time				07/21/2015 10:56:22 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Select (HMO)	01	01		1			H0154	008	0	2016	Central Alabama and Mobile Area		2	663	2			2							www.vivaprovider.com	http://www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	http://www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	(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	08/05/2015	2016.01	08/05/2015 08:36:14 AM Central Daylight Time	08/04/2015 09:49:10 AM Central Daylight Time	08/04/2015 09:50:05 AM Central Daylight Time			08/05/2015 10:35:22 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Premier (HMO)	01	01		1			H0154	011	0	2016	Central Alabama and Mobile Area		2	3246	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0154	012	0	1	01	01	H0154_012_0	7	2	1	08/05/2015	2016.01	08/05/2015 08:38:16 AM Central Daylight Time	08/04/2015 09:52:12 AM Central Daylight Time	08/04/2015 09:53:06 AM Central Daylight Time			08/05/2015 10:35:22 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Extra Value (HMO SNP)	01	01		1			H0154	012	0	2016	Central Alabama and Mobile Area		2	17128	2			1	3		1	4			www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0154	014	0	1	01	01	H0154_014_0	5		1	08/05/2015	2016.01	08/05/2015 08:43:28 AM Central Daylight Time	08/04/2015 09:57:43 AM Central Daylight Time	08/04/2015 09:59:23 AM Central Daylight Time			08/05/2015 10:35:22 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Me (HMO)	01	01		1			H0154	014	0	2016	Central Alabama		2	2933	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(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	08/05/2015	2016.01	08/05/2015 08:44:17 AM Central Daylight Time	08/04/2015 10:03:12 AM Central Daylight Time	08/04/2015 10:05:14 AM Central Daylight Time			08/05/2015 10:35:22 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com	VIVA Medicare Plus (HMO)	01	01		1			H0154	015	1	2016	Central Alabama and Mobile Area	Central Alabama and Mobile Area	2	17354	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(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	08/05/2015	2016.01	08/05/2015 08:44:28 AM Central Daylight Time	08/04/2015 10:07:38 AM Central Daylight Time	08/04/2015 10:08:21 AM Central Daylight Time			08/05/2015 10:35:22 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com	VIVA Medicare Plus (HMO)	01	01		1			H0154	015	2	2016	Central Alabama and Mobile Area	Anniston, Ft. Payne, Jasper, Troy, & Auburn Area	2	1695	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(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	4		1	05/31/2015	2016.01	05/31/2015 09:54:44 PM Central Daylight Time	07/20/2015 10:02:58 AM Central Daylight Time				07/21/2015 10:56:22 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Group Plan with Rx (CY) (HMO)	01	01		1			H0154	801	0	2016	State of Alabama		1	50	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;10a;11a;11b;11c;12;15;	1	7d;	1					2	2			
H0154	802	0	1	01	01	H0154_802_0	4		1	05/26/2015	2016.01	05/26/2015 06:53:05 PM Central Daylight Time	07/20/2015 10:03:41 AM Central Daylight Time				07/21/2015 10:56:22 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Group Plan (no Rx) (HMO)	01	01		1			H0154	802	0	2016	State of Alabama		1	50	2			2							www.vivaprovider.com	http://www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	http://www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;12;15;	1	7d;	1					2	2			
H0154	803	0	1	01	01	H0154_803_0	4		1	05/26/2015	2016.01	05/26/2015 06:54:52 PM Central Daylight Time	07/20/2015 10:04:37 AM Central Daylight Time				07/21/2015 10:56:22 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Plus Group Plan with Rx (not CY) (HMO)	01	01		1			H0154	803	0	2016	State of Alabama		1	50	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;12;15;	1	7d;	1					2	2			
H0174	001	0	1	01	01	H0174_001_0	5	2	1	08/03/2015	2016.01	08/03/2015 01:20:06 PM Central Daylight Time	08/03/2015 05:20:35 PM Central Daylight Time	07/31/2015 03:19:58 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	TODAY'S OPTIONS OF TEXAS, INC.	Universal American Corp.	http://www.universal-american-medicare.com/	TexanPlus Star (HMO SNP)	01	01		1			H0174	001	0	2016	Select counties in Southeast Texas		2		2			1	3		1	2			http://www.universal-american-medicare.com/	http://www.universal-american-medicare.com/todaysoptions	http://www.universal-american-medicare.com/todaysoptions	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0192	001	0	1	48	05	H0192_001_0	11		1	08/27/2015	2016.01	08/27/2015 11:18:56 AM Central Daylight Time					08/27/2015 11:44:00 AM Central Daylight Time	AMERIHEALTH MICHIGAN, INC.	AmeriHealth Caritas VIP Care Plus	www.amerihealthcaritasvipcareplus.com	AmeriHealth Caritas VIP Care PLUS (Medicare-Medicaid Plan)	05	48		1			H0192	001	0	2016	Wayne and Macomb Counties		2		2			2							www.amerihealthcaritasvipcareplus.com	www.amerihealthcaritasvipcareplus.com	www.amerihealthcaritasvipcareplus.com	(888)667-0318		(888)667-0318		(877)694-2316		(877)694-2316		(855)328-0011		(855)328-0011		(877)694-2316		(877)694-2316		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H0216	001	0	1	20	08	H0216_001_0	1		1	05/21/2015	2016.01	05/21/2015 07:01:00 PM Central Daylight Time		05/21/2015 08:26:06 AM Central Daylight Time			05/21/2015 07:05:41 PM Central Daylight Time	PACE IOWA	Immanuel Pathways	immanuelpathways.org	PACE Iowa (PACE)	08	20		1			H0216	001	0	2016	PACE Iowa		2		2			2								www.immanuelcommunities.com	www.immanuelcommunities.com									(800)000-0000		(712)256-7284		(800)000-0000		(712)256-7284										(800)000-0000		(712)256-7284		(800)000-0000		(712)256-7284																
H0216	002	0	1	20	08	H0216_002_0	1		1	05/21/2015	2016.01	05/21/2015 07:01:56 PM Central Daylight Time		05/21/2015 08:26:56 AM Central Daylight Time			05/21/2015 07:05:41 PM Central Daylight Time	PACE IOWA	Immanuel Pathways	immanuelpathways.org	PACE Iowa (PACE)	08	20		1			H0216	002	0	2016	PACE Iowa		2		2			2								www.immanuelcommunities.com	www.immanuelcommunities.com									(800)000-0000		(712)256-7284		(800)000-0000		(712)256-7284										(800)000-0000		(712)256-7284		(800)000-0000		(712)256-7284																
H0251	002	0	1	01	01	H0251_002_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:18:33 AM Central Daylight Time	07/31/2015 02:01:50 PM Central Daylight Time	07/30/2015 06:25:03 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0251	002	0	2016	Select counties in Tennessee		2		2			1	3		1	5			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			
H0281	001	0	1	48	05	H0281_001_0	2		1	07/06/2015	2016.01	07/06/2015 03:19:59 PM Central Daylight Time					07/06/2015 04:51:41 PM Central Daylight Time	ILLINICARE HEALTH PLAN	IlliniCare Health	http://mmp.illinicare.com	IlliniCare Health - MMAI (Medicare-Medicaid Plan)	05	48		1			H0281	001	0	2016	Cook, DuPage, Kane, Kankakee, Lake, Will Counties		2	500	2			2							http://apps.illinicare.com/findadoc/changeNetwork?prodId=1078	http://mmp.illinicare.com/resourcesmaterials/	http://apps.illinicare.com/findadoc/changeNetwork?prodId=1078	(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H0294	002	0	1	04	01	H0294_002_0	2		1	07/31/2015	2016.01	07/31/2015 12:31:39 PM Central Daylight Time	07/31/2015 01:09:48 PM Central Daylight Time	07/30/2015 06:25:48 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (PPO SNP)	01	04		1			H0294	002	0	2016	Various Counties in Wisconsin		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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	07/31/2015	2016.01	07/31/2015 12:40:10 PM Central Daylight Time	07/31/2015 01:10:11 PM Central Daylight Time	07/30/2015 06:26:34 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (PPO)	01	04		1			H0294	004	0	2016	Various Counties in Wisconsin		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0302	001	0	1	01	01	H0302_001_0	2		1	07/30/2015	2016.01	07/30/2015 09:13:56 AM US Mountain Standard Time	07/30/2015 01:28:23 PM US Mountain Standard Time	07/31/2015 03:56:15 PM US Mountain Standard Time			08/04/2015 03:15:12 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	2016	Maricopa County and part of Pinal County		2		2			2							azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(888)274-0367		(888)274-0367		(800)446-8331		(800)446-8331		(888)274-0367		(888)274-0367		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	006	0	1	01	01	H0302_006_0	2		1	07/30/2015	2016.01	07/30/2015 09:15:34 AM US Mountain Standard Time	07/30/2015 01:31:10 PM US Mountain Standard Time	07/31/2015 03:56:21 PM US Mountain Standard Time			08/04/2015 03:15:12 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	2016	Maricopa County and part of Pinal County		2		2			2							azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(888)274-0367		(888)274-0367		(800)446-8331		(800)446-8331		(888)274-0367		(888)274-0367		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	007	0	1	01	01	H0302_007_0	3		1	07/30/2015	2016.01	07/30/2015 09:16:31 AM US Mountain Standard Time	07/30/2015 01:48:04 PM US Mountain Standard Time	07/31/2015 03:56:26 PM US Mountain Standard Time			08/04/2015 03:15:12 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Premier (HMO)	01	01		1			H0302	007	0	2016	Maricopa County and part of Pinal County		2		2			2							azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(888)274-0367		(888)274-0367		(800)446-8331		(800)446-8331		(888)274-0367		(888)274-0367		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	008	0	1	01	01	H0302_008_0	2		1	07/30/2015	2016.01	07/30/2015 09:17:40 AM US Mountain Standard Time	07/30/2015 01:43:16 PM US Mountain Standard Time	07/31/2015 03:56:30 PM US Mountain Standard Time			08/04/2015 03:15:12 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	2016	Pima County		2		2			2							azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(888)274-0367		(888)274-0367		(800)446-8331		(800)446-8331		(888)274-0367		(888)274-0367		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	801	0	1	01	01	H0302_801_0	2		1	05/28/2015	2016.01	05/28/2015 02:17:13 PM US Mountain Standard Time	06/01/2015 12:22:17 PM US Mountain Standard Time				06/01/2015 06:02:19 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Employer Plan (HMO)	01	01		1			H0302	801	0	2016	Arizona		1		2			2							azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(888)274-0367		(888)274-0367										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7g;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;15;16b;	1	1a;5;6;7b;7c;7d;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;14d;14e;16b;18a;	1					1	2			
H0321	002	0	1	01	01	H0321_002_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:21:37 AM Central Daylight Time	07/31/2015 02:02:45 PM Central Daylight Time	07/30/2015 06:27:36 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0321	002	0	2016	Select counties in Arizona		2		2			1	3		1	4			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0321	004	0	1	01	01	H0321_004_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:21:55 AM Central Daylight Time	07/31/2015 02:03:10 PM Central Daylight Time	07/30/2015 06:28:37 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO SNP)	01	01		1			H0321	004	0	2016	Select counties in Arizona		2		2			1	3		1	4			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	2		1	07/09/2015	2016.01	07/09/2015 03:22:03 PM Central Daylight Time	05/29/2015 06:54:54 AM Central Daylight Time				07/09/2015 05:41:14 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential (HMO)	01	01		1			H0332	001	0	2016	Harris, Ft Bend, Galveston and Montgomery counties		2	3447	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	002	0	1	01	01	H0332_002_0	3		1	08/04/2015	2016.01	08/04/2015 09:17:09 AM Central Daylight Time	08/05/2015 07:18:20 AM Central Daylight Time	08/05/2015 07:20:49 AM Central Daylight Time			08/05/2015 07:41:55 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx (HMO)	01	01		1			H0332	002	0	2016	Harris, Ft Bend, Galveston and Montgomery counties		2	18870	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	003	0	1	02	01	H0332_003_0	2		1	07/09/2015	2016.01	07/09/2015 03:22:14 PM Central Daylight Time	05/29/2015 06:58:03 AM Central Daylight Time				07/09/2015 05:41:14 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice (HMO-POS)	01	02		1			H0332	003	0	2016	Harris, Ft Bend, Galveston and Montgomery counties		2	1232	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	004	0	1	02	01	H0332_004_0	3		1	08/04/2015	2016.01	08/04/2015 09:16:35 AM Central Daylight Time	08/05/2015 07:19:47 AM Central Daylight Time	08/05/2015 07:21:43 AM Central Daylight Time			08/05/2015 07:41:55 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice (HMO-POS)	01	02		1			H0332	004	0	2016	Harris, Ft Bend, Galveston and Montgomery counties		2	1247	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	801	0	1	01	01	H0332_801_0	2		1	05/28/2015	2016.01	05/28/2015 10:38:53 AM Central Daylight Time	07/22/2015 02:04:43 PM Central Daylight Time				07/24/2015 12:50:10 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	801	0	2016	Texas		1	9	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)534-0554		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	803	0	1	01	01	H0332_803_0	1		1	05/28/2015	2016.01	05/28/2015 10:39:34 AM Central Daylight Time	05/29/2015 01:59:01 PM Central Daylight Time				05/29/2015 02:36:55 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	803	0	2016	Texas		1	49	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		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	804	0	1	01	01	H0332_804_0	2		1	05/28/2015	2016.01	05/28/2015 10:39:57 AM Central Daylight Time	07/22/2015 02:04:47 PM Central Daylight Time				07/24/2015 12:50:10 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	2016	Texas		1	9	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)534-0554		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	805	0	1	01	01	H0332_805_0	1		1	05/28/2015	2016.01	05/28/2015 10:42:16 AM Central Daylight Time	05/29/2015 02:02:56 PM Central Daylight Time				05/29/2015 02:36:55 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	2016	Texas		1	59	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		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	806	0	1	01	01	H0332_806_0	1		1	05/28/2015	2016.01	05/28/2015 10:43:02 AM Central Daylight Time	05/29/2015 02:04:19 PM Central Daylight Time				05/29/2015 02:36:55 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	806	0	2016	Texas		1	1345	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(877)853-9075		(713)442-2377		(877)853-9075		(713)442-2377										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	807	0	1	01	01	H0332_807_0	1		1	05/28/2015	2016.01	05/28/2015 10:43:28 AM Central Daylight Time	05/29/2015 02:06:54 PM Central Daylight Time				05/29/2015 02:36:55 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	807	0	2016	Texas		1	9	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		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	808	0	1	01	01	H0332_808_0	2		1	05/28/2015	2016.01	05/28/2015 10:43:55 AM Central Daylight Time	07/22/2015 02:04:50 PM Central Daylight Time				07/24/2015 12:50:10 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	2016	Texas		1	9	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)534-0554		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	809	0	1	01	01	H0332_809_0	1		1	05/28/2015	2016.01	05/28/2015 10:44:15 AM Central Daylight Time	05/29/2015 02:10:22 PM Central Daylight Time				05/29/2015 02:36:55 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	2016	Texas		1	9	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		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	810	0	1	01	01	H0332_810_0	1		1	05/28/2015	2016.01	05/28/2015 10:45:45 AM Central Daylight Time	05/29/2015 02:11:34 PM Central Daylight Time				05/29/2015 02:36:55 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	810	0	2016	Texas		1	21	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		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	811	0	1	01	01	H0332_811_0	2		1	05/28/2015	2016.01	05/28/2015 10:47:06 AM Central Daylight Time	07/22/2015 02:04:53 PM Central Daylight Time				07/24/2015 12:50:10 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	811	0	2016	Texas		1	3586	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		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	812	0	1	01	01	H0332_812_0	2		1	05/28/2015	2016.01	05/28/2015 10:50:42 AM Central Daylight Time	07/22/2015 02:04:40 PM Central Daylight Time				07/24/2015 12:50:10 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	812	0	2016	Texas		1	9	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		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	813	0	1	01	01	H0332_813_0	1		1	05/28/2015	2016.01	05/28/2015 11:06:23 AM Central Daylight Time	05/29/2015 02:14:51 PM Central Daylight Time				05/29/2015 02:36:55 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage RX Retiree (HMO)	01	01		1			H0332	813	0	2016	Texas		1	9	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		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2	2			
H0332	814	0	1	01	01	H0332_814_0	1		1	05/28/2015	2016.01	05/28/2015 11:15:38 AM Central Daylight Time	05/29/2015 02:16:09 PM Central Daylight Time				05/29/2015 02:36:55 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	814	0	2016	Texas		1	9	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)534-0554		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0336	001	0	1	48	05	H0336_001_0	3		1	07/06/2015	2016.01	07/06/2015 03:47:46 PM Eastern Daylight Time					07/06/2015 03:55:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)	05	48		1			H0336	001	0	2016	Chicago Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)787-3311		(800)787-3311		(800)833-2364		(800)833-2364		(800)787-3311		(800)787-3311		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H0351	029	0	1	01	01	H0351_029_0	5	2	1	08/04/2015	2016.01	08/04/2015 11:14:43 AM Pacific Daylight Time	08/04/2015 12:25:47 PM Pacific Daylight Time	08/04/2015 09:47:46 AM Pacific Daylight Time			08/04/2015 01:31:09 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Amber (HMO SNP)	01	01		1			H0351	029	0	2016	Maricopa, AZ		2		2			1	3		1	4			www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	030	0	1	01	01	H0351_030_0	2		1	07/10/2015	2016.01	07/10/2015 01:10:54 PM Pacific Daylight Time	07/14/2015 08:08:14 AM Pacific Daylight Time				07/14/2015 11:34:13 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Green (HMO)	01	01		1			H0351	030	0	2016	Maricopa, Pinal, Sta Cruz, Cochise		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0351	038	0	1	01	01	H0351_038_0	3		1	08/03/2015	2016.01	08/03/2015 04:07:18 PM Pacific Daylight Time	08/04/2015 09:47:50 AM Pacific Daylight Time	08/04/2015 09:47:53 AM Pacific Daylight Time			08/04/2015 11:50:10 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Jade (HMO SNP)	01	01		1			H0351	038	0	2016	Maricopa and Pinal Counties		2		2			1	4		1		00000000000000000100		www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	040	0	1	01	01	H0351_040_0	3		1	07/30/2015	2016.01	07/30/2015 02:48:49 PM Pacific Daylight Time	08/04/2015 09:47:58 AM Pacific Daylight Time	08/04/2015 09:48:00 AM Pacific Daylight Time			08/04/2015 11:50:10 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0351	040	0	2016	Maricopa and Pinal  Counties, AZ		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	041	0	1	01	01	H0351_041_0	3		1	07/30/2015	2016.01	07/30/2015 02:49:59 PM Pacific Daylight Time	08/04/2015 09:48:04 AM Pacific Daylight Time	08/04/2015 09:48:06 AM Pacific Daylight Time			08/04/2015 11:50:10 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0351	041	0	2016	Pima County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	042	0	1	01	01	H0351_042_0	3		1	08/03/2015	2016.01	08/03/2015 04:07:52 PM Pacific Daylight Time	08/04/2015 09:48:10 AM Pacific Daylight Time	08/04/2015 09:48:12 AM Pacific Daylight Time			08/04/2015 11:50:10 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Jade Cardiovascular (HMO SNP)	01	01		1			H0351	042	0	2016	Maricopa and Pinal Counties		2		2			1	4		1		00010000000000000000		www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	043	1	1	01	01	H0351_043_1	3		1	07/31/2015	2016.01	07/31/2015 09:33:07 AM Pacific Daylight Time	08/04/2015 09:48:16 AM Pacific Daylight Time	08/04/2015 09:48:19 AM Pacific Daylight Time			08/04/2015 11:50:10 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby 1 (HMO)	01	01		1			H0351	043	1	2016	Maricopa, Pinal, Santa Cruz Counties, AZ	Maricopa and Pinal Counties, AZ	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	043	3	1	01	01	H0351_043_3	3		1	07/31/2015	2016.01	08/04/2015 11:25:55 AM Pacific Daylight Time	08/04/2015 09:48:23 AM Pacific Daylight Time	08/04/2015 09:48:26 AM Pacific Daylight Time			08/04/2015 11:50:10 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby 1 (HMO)	01	01		1			H0351	043	3	2016	Maricopa, Pinal, Santa Cruz Counties, AZ	Santa Cruz County, AZ	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	044	1	1	01	01	H0351_044_1	3		1	07/31/2015	2016.01	07/31/2015 10:15:26 AM Pacific Daylight Time	08/04/2015 09:48:30 AM Pacific Daylight Time	08/04/2015 09:48:32 AM Pacific Daylight Time			08/04/2015 11:50:10 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby 4 (HMO)	01	01		1			H0351	044	1	2016	Cochise, Pima, Santa Cruz	Pima and Santa Cruz, AZ	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	044	2	1	01	01	H0351_044_2	3		1	07/31/2015	2016.01	08/04/2015 11:29:17 AM Pacific Daylight Time	08/04/2015 09:48:37 AM Pacific Daylight Time	08/04/2015 09:48:40 AM Pacific Daylight Time			08/04/2015 11:50:10 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby 4 (HMO)	01	01		1			H0351	044	2	2016	Cochise, Pima, Santa Cruz	Cochise, AZ	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	801	0	1	01	01	H0351_801_0	2		1	05/29/2015	2016.01	05/29/2015 10:45:42 AM US Mountain Standard Time	05/29/2015 11:45:20 AM Pacific Daylight Time				05/30/2015 02:18:50 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net EG (HMO)	01	01		1			H0351	801	0	2016	All AZ Counties		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0351	803	0	1	01	01	H0351_803_0	2		1	04/15/2015	2016.01	04/15/2015 11:36:12 AM US Mountain Standard Time	05/29/2015 11:45:20 AM Pacific Daylight Time				05/30/2015 02:18:50 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net EG (HMO)	01	01		1			H0351	803	0	2016	All AZ Counties		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0351	804	0	1	01	01	H0351_804_0	2		1	04/15/2015	2016.01	04/15/2015 11:37:36 AM US Mountain Standard Time	05/29/2015 11:45:19 AM Pacific Daylight Time				05/30/2015 02:18:50 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net EG (HMO)	01	01		1			H0351	804	0	2016	All AZ Counties		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0354	001	0	1	01	01	H0354_001_0	6		1	07/21/2015	2016.01	07/21/2015 08:59:01 AM Central Daylight Time	07/31/2015 07:53:39 PM Central Daylight Time	07/30/2015 08:06:47 AM Central Daylight Time			08/03/2015 04:04:20 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0354	001	0	2016	Maricopa Co. and Select Zip Codes in Pinal Co.		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	8b1;9b;	
H0354	023	0	1	01	01	H0354_023_0	5		1	07/21/2015	2016.01	07/21/2015 08:59:18 AM Central Daylight Time	07/31/2015 07:53:39 PM Central Daylight Time	07/30/2015 08:07:19 AM Central Daylight Time			08/03/2015 04:04:20 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred Plus (HMO)	01	01		1			H0354	023	0	2016	Maricopa Co. and Select Zip Codes in Pinal Co.		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	8b1;9b;	
H0354	024	0	1	01	01	H0354_024_0	4		1	07/15/2015	2016.01	07/15/2015 02:40:53 PM Central Daylight Time	07/31/2015 07:53:39 PM Central Daylight Time	07/30/2015 08:07:48 AM Central Daylight Time			08/03/2015 04:04:20 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0354	024	0	2016	Pima County		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	026	0	1	01	01	H0354_026_0	4		1	07/15/2015	2016.01	07/15/2015 02:41:17 PM Central Daylight Time	07/31/2015 07:53:39 PM Central Daylight Time	07/30/2015 08:08:20 AM Central Daylight Time			08/03/2015 04:04:20 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred Plus (HMO)	01	01		1			H0354	026	0	2016	Pima County		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	027	0	1	01	01	H0354_027_0	6		1	07/21/2015	2016.01	07/21/2015 08:59:56 AM Central Daylight Time	07/31/2015 07:53:39 PM Central Daylight Time	07/30/2015 08:08:49 AM Central Daylight Time			08/03/2015 04:04:20 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Achieve Plus (HMO SNP)	01	01		1			H0354	027	0	2016	Maricopa Co. and Select Zip Codes in Pinal Co.		2		2			1	4		1		00000010000000000000		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	8b1;9b;	
H0354	804	0	1	01	01	H0354_804_0	4		1	05/15/2015	2016.01	05/15/2015 08:35:15 AM US Mountain Standard Time	07/12/2015 09:12:53 AM Central Daylight Time				07/16/2015 11:02:24 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H0354	804	0	2016	All Counties in Arizona		1	0	2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7d;7f;7h;7i;8a;8b1;8b2;9a;9b;9c;11a;11b;12;15;	1	6;7c;7d;7i;8b1;8b2;8b3;9a;9d;12;14a;16b;18a;	1					1	2			
H0354	805	0	1	01	01	H0354_805_0	4		1	05/15/2015	2016.01	05/15/2015 08:35:47 AM US Mountain Standard Time	07/12/2015 09:13:22 AM Central Daylight Time				07/16/2015 11:02:24 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H0354	805	0	2016	All Counties in Arizona		1	0	2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7d;7f;7h;7i;8a;8b1;8b2;9a;9b;9c;11a;11b;12;15;	1	6;7c;7d;7i;8b1;8b2;8b3;9a;9d;12;14a;16b;18a;	1					1	2			
H0390	001	0	1	20	08	H0390_001_0	2		1	05/21/2015	2016.01	05/21/2015 10:36:01 AM Eastern Daylight Time		05/20/2015 03:54:49 PM Eastern Daylight Time			05/21/2015 10:38:04 AM Eastern Daylight Time	PACE OF SOUTHWEST MICHIGAN, INC.	PACE of Southwest Michigan	theresesaggau@paceswmi.org	PACE of Southwest Michigan - Dual (PACE)	08	20		1			H0390	001	0	2016	PACE of Southwest Michigan - Dual		2		2			2								theresesaggau@paceswmi.org	www.seniorscript.com									(855)243-8876		(269)408-4324		(855)243-8876		(269)408-4324										(855)243-8876		(269)408-4324		(855)243-8876		(269)408-4324																
H0390	002	0	1	20	08	H0390_002_0	2		1	05/21/2015	2016.01	05/21/2015 10:36:41 AM Eastern Daylight Time		05/20/2015 03:57:12 PM Eastern Daylight Time			05/21/2015 10:38:04 AM Eastern Daylight Time	PACE OF SOUTHWEST MICHIGAN, INC.	PACE of Southwest Michigan	theresesaggau@paceswmi.org	PACE of Southwest Michigan - Medicare Only (PACE)	08	20		1			H0390	002	0	2016	PACE of Southwest Michigan - Medicare Only		2		2			2								theresesaggau@paceswmi.org	www.seniorscript.com									(855)243-8876		(269)408-4324		(855)243-8876		(269)408-4324										(855)243-8876		(269)408-4324		(855)243-8876		(269)408-4324																
H0408	002	0	1	02	01	H0408_002_0	3		1	07/10/2015	2016.01	07/10/2015 02:04:32 PM Central Daylight Time	07/31/2015 02:03:58 PM Central Daylight Time	07/30/2015 06:29:31 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H0408	002	0	2016	Nashville and Knoxville Metro areas		2		2			1	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			
H0408	003	0	1	01	01	H0408_003_0	3		1	07/31/2015	2016.01	07/31/2015 12:00:48 PM Central Daylight Time	07/31/2015 02:04:24 PM Central Daylight Time	07/30/2015 06:30:16 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H0408	003	0	2016	Nashville area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0423	001	0	1	01	01	H0423_001_0	8	2	1	07/02/2015	2016.01	07/02/2015 01:25:46 PM Eastern Daylight Time	07/10/2015 05:22:13 PM Eastern Daylight Time	07/10/2015 05:26:52 PM Eastern Daylight Time			07/14/2015 03:35:00 PM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Advantage Plan (HMO SNP)	01	01		1			H0423	001	0	2016	NYC - The Bronx, Brooklyn, Manhattan, Queens		2		2			1	3		1	2			www.metroplusmedicare.org	https://www.metroplus.org/CMSPages/GetFile.aspx?guid=3ee42e68-06ac-4431-8445-a77d6a8e117e	www.caremark.com	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0423	004	0	1	01	01	H0423_004_0	9		1	07/08/2015	2016.01	07/08/2015 10:05:36 AM Eastern Daylight Time	08/03/2015 04:25:14 PM Eastern Daylight Time	07/30/2015 09:32:55 AM Eastern Daylight Time			08/03/2015 04:53:01 PM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Platinum (HMO)	01	01		1			H0423	004	0	2016	NYC - The Bronx, Brooklyn, Manhattan, Queens		2	1935	2			2							www.metroplusmedicare.org	https://www.metroplus.org/CMSPages/GetFile.aspx?guid=3ee42e68-06ac-4431-8445-a77d6a8e117e	www.caremark.com	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0435	001	0	1	01	01	H0435_001_0	7		1	07/10/2015	2016.01	07/10/2015 01:04:40 PM Central Daylight Time	07/23/2015 09:06:55 PM Central Daylight Time				07/23/2015 10:21:26 PM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth.com/medicare	GlobalHealth Medicare Option 1 (HMO)	01	01		1			H0435	001	0	2016	Oklahoma		2	75	2			2							www.globalhealth-medicare.com/search.aspx	www.globalhealth-medicare.com	www.globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0435	002	0	1	01	01	H0435_002_0	10		1	07/06/2015	2016.01	07/06/2015 01:43:47 PM Central Daylight Time	08/05/2015 03:30:50 PM Central Daylight Time	08/05/2015 03:30:50 PM Central Daylight Time			08/05/2015 03:45:14 PM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth.com/medicare	GlobalHealth Medicare Option 2 (HMO)	01	01		1			H0435	002	0	2016	Oklahoma		2	385	2			2							www.globalhealth-medicare.com/search.aspx	www.globalhealth.com/medicare_materials.aspx	www.globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774		(866)844-0151		(866)844-0151		(877)280-5774		(405)280-5774		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0435	003	0	1	01	01	H0435_003_0	9		1	07/10/2015	2016.01	07/10/2015 01:01:11 PM Central Daylight Time	08/05/2015 03:30:50 PM Central Daylight Time	08/05/2015 03:30:50 PM Central Daylight Time			08/05/2015 03:45:14 PM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth.com/medicare	GlobalHealth Medicare Option 3 (HMO)	01	01		1			H0435	003	0	2016	Oklahoma		2	200	2			2							www.globalhealth-medicare.com/search.aspx	www.globalhealth.com/medicare_materials.aspx	www.globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774		(866)844-0151		(866)844-0151		(877)280-5774		(405)280-5774		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0435	004	0	1	01	01	H0435_004_0	7		1	07/06/2015	2016.01	07/06/2015 01:45:00 PM Central Daylight Time	08/05/2015 03:30:51 PM Central Daylight Time	08/05/2015 03:30:51 PM Central Daylight Time			08/05/2015 03:45:14 PM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth.com/medicare	GlobalHealth Medicare Option 4 (HMO)	01	01		1			H0435	004	0	2016	Oklahoma		2	650	2			2							www.globalhealth-medicare.com/search.aspx	www.globalhealth.com/medicare_materials.aspx	www.globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774		(866)844-0151		(866)844-0151		(877)280-5774		(405)280-5774		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0435	005	0	1	01	01	H0435_005_0	8		1	08/07/2015	2016.01	08/07/2015 09:28:33 AM Central Daylight Time	08/05/2015 03:30:51 PM Central Daylight Time	08/05/2015 03:30:45 PM Central Daylight Time			08/07/2015 10:52:19 AM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth.com/medicare	GlobalHealth Medicare Option 5 (HMO)	01	01		1			H0435	005	0	2016	Oklahoma		2	320	2			2							www.globalhealth-medicare.com/search.aspx	www.globalhealth.com/medicare_materials.aspx	www.globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774		(866)844-0151		(866)844-0151		(877)280-5774		(405)280-5774		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	001	0	1	01	01	H0439_001_0	4		1	07/14/2015	2016.01	07/14/2015 03:54:49 PM Central Daylight Time	08/01/2015 09:45:47 AM Central Daylight Time	07/30/2015 08:09:21 AM Central Daylight Time			08/03/2015 04:10:23 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0439	001	0	2016	Georgia		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	002	0	1	01	01	H0439_002_0	4	2	1	07/31/2015	2016.01	07/31/2015 09:28:20 AM Central Daylight Time	08/01/2015 09:46:16 AM Central Daylight Time	07/30/2015 08:09:53 AM Central Daylight Time			08/03/2015 04:10:23 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H0439	002	0	2016	Georgia		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	801	0	1	01	01	H0439_801_0	3		1	05/21/2015	2016.01	05/21/2015 09:01:52 PM Central Daylight Time	07/13/2015 04:33:07 PM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H0439	801	0	2016	Georgia		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)737-1879		(888)737-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H0439	802	0	1	02	01	H0439_802_0	3		1	05/21/2015	2016.01	05/21/2015 09:02:24 PM Central Daylight Time	07/13/2015 04:33:37 PM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H0439	802	0	2016	Georgia		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H0439	803	0	1	01	01	H0439_803_0	3		1	05/21/2015	2016.01	05/21/2015 09:02:49 PM Central Daylight Time	07/13/2015 04:34:07 PM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H0439	803	0	2016	Georgia		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H0439	804	0	1	02	01	H0439_804_0	3		1	05/21/2015	2016.01	05/21/2015 09:03:11 PM Central Daylight Time	07/13/2015 04:34:36 PM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H0439	804	0	2016	Georgia		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H0439	805	0	1	01	01	H0439_805_0	3		1	05/21/2015	2016.01	05/21/2015 09:03:35 PM Central Daylight Time	07/13/2015 04:35:07 PM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H0439	805	0	2016	Georgia		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H0439	806	0	1	02	01	H0439_806_0	3		1	05/27/2015	2016.01	05/27/2015 04:50:02 PM Central Daylight Time	07/13/2015 04:35:39 PM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H0439	806	0	2016	Georgia		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H0477	001	0	1	20	08	H0477_001_0	1		1	06/01/2015	2016.01	06/01/2015 03:17:44 PM Eastern Daylight Time		06/01/2015 03:22:14 PM Eastern Daylight Time			06/01/2015 03:24:38 PM Eastern Daylight Time	SERENITY CARE, INC.	Serenity Care PACE	n/a	Serenity PACE Dual (PACE)	08	20		1			H0477	001	0	2016	Serenity Pace Dual		2		2			2								www.pharmastarpbm.com	www.omnicare.com									(413)627-9772		(413)627-9772		(413)627-9772		(413)627-9772										(413)627-9772		(413)627-9772		(413)627-9772		(413)627-9772																
H0477	002	0	1	20	08	H0477_002_0	1		1	06/01/2015	2016.01	06/01/2015 03:17:59 PM Eastern Daylight Time		06/01/2015 03:22:04 PM Eastern Daylight Time			06/01/2015 03:24:38 PM Eastern Daylight Time	SERENITY CARE, INC.	Serenity Care PACE	n/a	Serenity PACE Medicare only (PACE)	08	20		1			H0477	002	0	2016	Serenity PACE Medicare only		2		2			2								www.pharmastarpbm.com	www.omnicare.com									(413)627-9772		(413)627-9772		(413)627-9772		(413)627-9772										(413)627-9772		(413)627-9772		(413)627-9772		(413)627-9772																
H0480	001	0	1	48	05	H0480_001_0	4		1	07/22/2015	2016.01	07/22/2015 08:13:07 AM Eastern Daylight Time					07/22/2015 08:16:08 AM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Meridian Complete	www.medicaremeridian.com	Meridian Complete (Medicare-Medicaid Plan)	05	48		1			H0480	001	0	2016	Southwestern Michigan		2		2			2							www.medicaremeridian.com	www.mhplan.com	www.mhplan.com	(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H0490	004	0	1	01	01	H0490_004_0	6	2	1	08/05/2015	2016.01	08/05/2015 03:27:18 PM Pacific Daylight Time	08/04/2015 04:12:38 PM Pacific Daylight Time	07/30/2015 08:57:12 AM Pacific Daylight Time			08/05/2015 04:11:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H0490	004	0	2016	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			
H0504	015	0	1	01	01	H0504_015_0	5		1	08/04/2015	2016.01	08/04/2015 02:40:17 PM Pacific Daylight Time	08/05/2015 03:15:42 PM Pacific Daylight Time	08/04/2015 02:52:32 PM Pacific Daylight Time			08/05/2015 04:55:27 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	015	0	2016	Los Angeles (Partial)/Orange Counties		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	017	0	1	01	01	H0504_017_0	6		1	08/04/2015	2016.01	08/04/2015 02:27:22 PM Pacific Daylight Time	08/05/2015 03:17:19 PM Pacific Daylight Time	08/04/2015 05:44:08 PM Pacific Daylight Time			08/05/2015 04:51:44 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	017	0	2016	San Bernardino County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	021	0	1	01	01	H0504_021_0	6		1	09/21/2015	2016.01	09/21/2015 12:43:06 PM Pacific Daylight Time	08/05/2015 03:18:22 PM Pacific Daylight Time	08/04/2015 05:45:51 PM Pacific Daylight Time			09/21/2015 12:47:03 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus Choice Plan (HMO)	01	01		1			H0504	021	0	2016	Los Angeles (Partial)/Orange Counties CP		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	026	0	1	01	01	H0504_026_0	5		1	08/04/2015	2016.01	08/04/2015 02:28:08 PM Pacific Daylight Time	08/05/2015 03:20:59 PM Pacific Daylight Time	08/04/2015 05:52:28 PM Pacific Daylight Time			08/05/2015 04:41:38 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	026	0	2016	Riverside County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	027	0	1	01	01	H0504_027_0	5		1	08/04/2015	2016.01	08/04/2015 02:29:59 PM Pacific Daylight Time	08/05/2015 03:22:14 PM Pacific Daylight Time	08/04/2015 05:53:37 PM Pacific Daylight Time			08/05/2015 04:36:48 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	027	0	2016	Sacramento County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	028	0	1	01	01	H0504_028_0	5		1	08/05/2015	2016.01	08/05/2015 11:44:15 AM Pacific Daylight Time	08/05/2015 03:23:17 PM Pacific Daylight Time	08/04/2015 05:54:45 PM Pacific Daylight Time			08/05/2015 04:32:44 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	028	0	2016	San Diego County		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	029	0	1	01	01	H0504_029_0	5		1	08/04/2015	2016.01	08/04/2015 02:36:08 PM Pacific Daylight Time	08/05/2015 03:24:24 PM Pacific Daylight Time	08/04/2015 05:56:12 PM Pacific Daylight Time			08/05/2015 04:12:49 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	029	0	2016	Ventura County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	030	0	1	01	01	H0504_030_0	6		1	08/04/2015	2016.01	08/04/2015 02:37:01 PM Pacific Daylight Time	08/05/2015 03:25:39 PM Pacific Daylight Time	08/04/2015 05:57:12 PM Pacific Daylight Time			08/05/2015 04:17:15 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	030	0	2016	Contra Costa County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	031	0	1	01	01	H0504_031_0	6		1	08/04/2015	2016.01	08/04/2015 02:38:17 PM Pacific Daylight Time	08/05/2015 03:26:55 PM Pacific Daylight Time	08/04/2015 05:58:13 PM Pacific Daylight Time			08/05/2015 04:20:54 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	031	0	2016	Fresno County		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	032	0	1	01	01	H0504_032_0	6		1	08/04/2015	2016.01	08/04/2015 02:39:26 PM Pacific Daylight Time	08/05/2015 03:28:42 PM Pacific Daylight Time	08/04/2015 05:59:21 PM Pacific Daylight Time			08/05/2015 04:24:56 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	032	0	2016	Santa Clara County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	803	0	1	01	01	H0504_803_0	1		1	05/27/2015	2016.01	05/27/2015 12:55:38 PM Pacific Daylight Time	05/31/2015 11:19:16 PM Pacific Daylight Time				06/01/2015 02:13:08 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	803	0	2016	MA-PD Employer Group Plan		1		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	2					2	2			
H0504	804	0	1	01	01	H0504_804_0	1		1	05/23/2015	2016.01	05/23/2015 01:06:11 PM Pacific Daylight Time	05/31/2015 11:23:16 PM Pacific Daylight Time				06/01/2015 02:14:59 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	804	0	2016	MA-PD Employer Group Plan		1		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	2					2	2			
H0504	805	0	1	01	01	H0504_805_0	1		1	05/23/2015	2016.01	05/23/2015 01:07:54 PM Pacific Daylight Time	05/31/2015 11:26:35 PM Pacific Daylight Time				06/01/2015 02:16:28 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	805	0	2016	MA-Only Employer Group Plan		1		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	2					2	2			
H0523	002	0	1	01	01	H0523_002_0	8		1	07/16/2015	2016.01	07/16/2015 12:34:57 PM Pacific Daylight Time	08/03/2015 08:52:48 AM Eastern Daylight Time	07/29/2015 04:56:27 PM Eastern Daylight Time			08/03/2015 10:21:45 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	002	0	2016	Los Angeles and Orange Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	022	0	1	01	01	H0523_022_0	10		1	08/04/2015	2016.01	08/04/2015 11:04:36 AM Eastern Daylight Time	08/05/2015 09:34:35 AM Eastern Daylight Time	07/29/2015 04:56:46 PM Eastern Daylight Time			08/05/2015 10:46:14 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	022	0	2016	Riverside and San Bernardino Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	031	0	1	01	01	H0523_031_0	10		1	08/04/2015	2016.01	08/04/2015 11:05:08 AM Eastern Daylight Time	08/05/2015 09:37:08 AM Eastern Daylight Time	07/29/2015 04:57:05 PM Eastern Daylight Time			08/05/2015 10:46:14 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	031	0	2016	Kern County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	052	0	1	01	01	H0523_052_0	8		1	08/03/2015	2016.01	08/03/2015 08:22:48 AM Eastern Daylight Time	08/03/2015 09:11:03 AM Eastern Daylight Time	07/29/2015 04:57:24 PM Eastern Daylight Time			08/03/2015 10:21:45 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	052	0	2016	San Diego County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	060	0	1	01	01	H0523_060_0	7		1	08/04/2015	2016.01	08/04/2015 11:05:43 AM Eastern Daylight Time	08/03/2015 08:58:11 AM Eastern Daylight Time	07/29/2015 04:57:43 PM Eastern Daylight Time			08/04/2015 03:01:45 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H0523	060	0	2016	Orange County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	061	0	1	01	01	H0523_061_0	8		1	08/04/2015	2016.01	08/04/2015 11:06:19 AM Eastern Daylight Time	08/03/2015 08:59:24 AM Eastern Daylight Time	07/29/2015 04:58:01 PM Eastern Daylight Time			08/04/2015 03:01:45 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	2016	Los Angeles County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	063	0	1	01	01	H0523_063_0	7		1	08/04/2015	2016.01	08/04/2015 11:06:35 AM Eastern Daylight Time	08/03/2015 09:00:34 AM Eastern Daylight Time	07/29/2015 04:58:20 PM Eastern Daylight Time			08/04/2015 03:01:45 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H0523	063	0	2016	San Bernardino County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	801	0	1	01	01	H0523_801_0	6		1	06/01/2015	2016.01	06/01/2015 10:50:23 AM Eastern Daylight Time	07/17/2015 11:02:56 AM Eastern Daylight Time				07/17/2015 05:03:14 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H0523	801	0	2016	California		1	630	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1	2			
H0523	805	0	1	01	01	H0523_805_0	4		1	05/29/2015	2016.01	05/29/2015 12:10:53 PM Eastern Daylight Time	07/17/2015 11:07:36 AM Eastern Daylight Time				07/17/2015 05:03:14 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H0523	805	0	2016	California		1	850	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H0524	002	0	2	01	01	H0524_002_0	6		1	07/10/2015	2016.01	07/10/2015 09:27:40 AM Pacific Daylight Time	08/03/2015 05:34:24 PM Pacific Daylight Time	08/03/2015 02:02:15 PM Pacific Daylight Time			08/04/2015 05:41:29 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage B Only South (HMO)	01	01		2	1		H0524	002	0	2016	Part B Only Southern California Area		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	003	0	1	01	01	H0524_003_0	5		1	07/31/2015	2016.01	07/31/2015 01:55:27 PM Pacific Daylight Time	08/03/2015 05:36:22 PM Pacific Daylight Time	08/03/2015 02:03:49 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Los Angeles and Orange Counties Plan		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	008	0	1	01	01	H0524_008_0	6		1	07/10/2015	2016.01	07/10/2015 09:27:48 AM Pacific Daylight Time	08/03/2015 03:04:04 PM Pacific Daylight Time	08/03/2015 02:18:09 PM Pacific Daylight Time			08/04/2015 05:41:29 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Solano (HMO)	01	01		1			H0524	008	0	2016	Solano County Plan		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	010	0	2	01	01	H0524_010_0	5		1	07/10/2015	2016.01	07/10/2015 09:27:53 AM Pacific Daylight Time	08/03/2015 05:07:28 PM Pacific Daylight Time	08/03/2015 02:19:43 PM Pacific Daylight Time			08/04/2015 05:41:29 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage B Only North (HMO)	01	01		2	1		H0524	010	0	2016	Part B Only Northern California Area		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	013	0	1	01	01	H0524_013_0	6		1	07/10/2015	2016.01	07/10/2015 09:27:58 AM Pacific Daylight Time	08/03/2015 05:10:53 PM Pacific Daylight Time	08/03/2015 02:21:14 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Greater Sac and Sonoma County Plan - Enhanced		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/31/2015	2016.01	07/31/2015 01:55:33 PM Pacific Daylight Time	08/03/2015 05:38:17 PM Pacific Daylight Time	08/03/2015 02:05:18 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Inland Empire Plan		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0524	029	0	1	01	01	H0524_029_0	6	2	1	07/10/2015	2016.01	07/10/2015 11:36:13 AM Pacific Daylight Time	08/03/2015 05:49:56 PM Pacific Daylight Time	08/03/2015 02:14:06 PM Pacific Daylight Time			08/04/2015 05:41:29 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)	01	01		1			H0524	029	0	2016	Southern California Plan		2		2			1	3		1	3		2	kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	6	2	1	07/10/2015	2016.01	07/10/2015 09:28:13 AM Pacific Daylight Time	08/03/2015 05:47:55 PM Pacific Daylight Time	08/03/2015 02:12:38 PM Pacific Daylight Time			08/04/2015 05:41:29 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Plan North (HMO SNP)	01	01		1			H0524	030	0	2016	Northern California Plan		2		2			1	3		1	3		2	kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	4		1	07/10/2015	2016.01	07/10/2015 09:28:18 AM Pacific Daylight Time	08/03/2015 05:12:51 PM Pacific Daylight Time	08/03/2015 02:22:49 PM Pacific Daylight Time			08/04/2015 05:41:29 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Marin San Mateo (HMO)	01	01		1			H0524	031	0	2016	Marin and San Mateo Counties Plan		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/10/2015	2016.01	07/10/2015 09:28:23 AM Pacific Daylight Time	08/03/2015 05:14:48 PM Pacific Daylight Time	08/03/2015 02:24:18 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Alameda, Napa, and SF Counties Plan		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/10/2015	2016.01	07/10/2015 09:28:28 AM Pacific Daylight Time	08/03/2015 05:16:46 PM Pacific Daylight Time	08/03/2015 02:25:49 PM Pacific Daylight Time			08/04/2015 05:41:29 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Contra Costa (HMO)	01	01		1			H0524	033	0	2016	Contra Costa County Plan		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/31/2015	2016.01	07/31/2015 01:55:40 PM Pacific Daylight Time	08/03/2015 05:40:13 PM Pacific Daylight Time	08/03/2015 02:06:49 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Ventura County Plan		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	7		1	07/31/2015	2016.01	07/31/2015 01:55:45 PM Pacific Daylight Time	08/03/2015 05:42:10 PM Pacific Daylight Time	08/03/2015 02:08:16 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Kern County Plan - Enhanced		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	6		1	07/31/2015	2016.01	07/31/2015 01:55:50 PM Pacific Daylight Time	08/03/2015 05:44:05 PM Pacific Daylight Time	08/03/2015 02:09:43 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Kern County Plan - Basic		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/31/2015	2016.01	07/31/2015 01:55:55 PM Pacific Daylight Time	08/03/2015 05:46:01 PM Pacific Daylight Time	08/03/2015 02:11:11 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	San Diego County Plan		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/10/2015	2016.01	07/10/2015 09:28:51 AM Pacific Daylight Time	08/03/2015 05:18:45 PM Pacific Daylight Time	08/03/2015 02:27:18 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Greater Fresno Area Plan - Enhanced		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/10/2015	2016.01	07/10/2015 09:28:56 AM Pacific Daylight Time	08/03/2015 05:20:41 PM Pacific Daylight Time	08/03/2015 02:28:46 PM Pacific Daylight Time			08/04/2015 05:41:29 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Santa Clara (HMO)	01	01		1			H0524	039	0	2016	Santa Clara County Plan		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/10/2015	2016.01	07/10/2015 09:29:02 AM Pacific Daylight Time	08/03/2015 05:22:39 PM Pacific Daylight Time	08/03/2015 02:30:14 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Stanislaus County Plan - Enhanced		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/31/2015	2016.01	07/31/2015 01:56:02 PM Pacific Daylight Time	08/03/2015 05:24:34 PM Pacific Daylight Time	08/03/2015 02:31:46 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Stanislaus County Plan - Basic		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/10/2015	2016.01	07/10/2015 09:29:11 AM Pacific Daylight Time	08/03/2015 05:26:33 PM Pacific Daylight Time	08/03/2015 02:33:14 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	San Joaquin County Plan - Enhanced		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/31/2015	2016.01	07/31/2015 01:56:11 PM Pacific Daylight Time	08/03/2015 05:28:30 PM Pacific Daylight Time	08/03/2015 02:34:43 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	San Joaquin County Plan - Basic		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	08/03/2015	2016.01	08/03/2015 08:45:32 AM Pacific Daylight Time	08/03/2015 05:30:26 PM Pacific Daylight Time	08/03/2015 02:36:14 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Greater Fresno Area Plan - Basic		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	5		1	07/31/2015	2016.01	07/31/2015 01:56:21 PM Pacific Daylight Time	08/03/2015 05:32:21 PM Pacific Daylight Time	08/03/2015 02:37:47 PM Pacific Daylight Time			08/04/2015 05:41:29 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	2016	Greater Sac and Sonoma County Plan - Basic		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	3		1	05/20/2015	2016.01	05/20/2015 11:13:00 AM Pacific Daylight Time	07/07/2015 12:35:23 PM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	801	0	2016	Southern California Group Part A B		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;11a;11b;11c;15;16b;	1	5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	802	0	1	01	01	H0524_802_0	3		1	05/20/2015	2016.01	05/20/2015 11:13:34 AM Pacific Daylight Time	07/09/2015 10:50:26 AM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	802	0	2016	Northern California Group Part A B		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;11a;11b;11c;15;16b;	1	5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	803	0	2	01	01	H0524_803_0	3		1	05/28/2015	2016.01	05/28/2015 03:28:06 PM Pacific Daylight Time	07/09/2015 11:10:16 AM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	803	0	2016	Southern California Group B Only		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;11a;11b;11c;15;16b;	1	5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	804	0	2	01	01	H0524_804_0	3		1	05/08/2015	2016.01	05/08/2015 12:36:37 PM Pacific Daylight Time	07/09/2015 10:53:20 AM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	804	0	2016	Northern California Group B Only		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;11a;11b;11c;15;16b;	1	5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	805	0	1	01	01	H0524_805_0	3		1	05/07/2015	2016.01	05/07/2015 04:08:13 PM Pacific Daylight Time	07/07/2015 12:38:56 PM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	805	0	2016	Southern California Group Part A B Part D		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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;11a;11b;11c;15;16b;	1	5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	806	0	1	01	01	H0524_806_0	3		1	05/08/2015	2016.01	05/08/2015 12:37:12 PM Pacific Daylight Time	07/09/2015 10:57:47 AM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	806	0	2016	Northern California Group Part A B Part D		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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;11a;11b;11c;15;16b;	1	5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	807	0	2	01	01	H0524_807_0	3		1	05/07/2015	2016.01	05/07/2015 04:08:33 PM Pacific Daylight Time	07/07/2015 12:40:42 PM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	807	0	2016	Southern California Group Part B only  Part D		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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;11a;11b;11c;15;16b;	1	5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	808	0	2	01	01	H0524_808_0	3		1	05/08/2015	2016.01	05/08/2015 12:37:43 PM Pacific Daylight Time	07/09/2015 11:01:18 AM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	808	0	2016	Northern California Group Part B only Part D		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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;11a;11b;11c;15;16b;	1	5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	809	0	1	01	01	H0524_809_0	3		1	05/07/2015	2016.01	05/07/2015 04:08:52 PM Pacific Daylight Time	07/07/2015 12:42:29 PM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	01	01		1			H0524	809	0	2016	Southern California Plan		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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;11a;11b;11c;15;16b;	1	5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	810	0	1	01	01	H0524_810_0	3		1	05/08/2015	2016.01	05/08/2015 12:38:32 PM Pacific Daylight Time	07/09/2015 11:04:18 AM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	01	01		1			H0524	810	0	2016	Northern California Plan		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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;11a;11b;11c;15;16b;	1	5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	811	0	2	01	01	H0524_811_0	3		1	05/07/2015	2016.01	05/07/2015 04:09:14 PM Pacific Daylight Time	07/09/2015 11:20:45 AM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	01	01		2	1		H0524	811	0	2016	Southern California Plan		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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;11a;11b;11c;15;16b;	1	5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0524	812	0	2	01	01	H0524_812_0	3		1	05/08/2015	2016.01	05/08/2015 12:39:05 PM Pacific Daylight Time	07/09/2015 11:07:09 AM Pacific Daylight Time				07/13/2015 01:04:48 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	01	01		2	1		H0524	812	0	2016	Northern California Plan		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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;11a;11b;11c;15;16b;	1	5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;14a;14d;16b;18a;	1					2	2			
H0542	001	0	1	20	08	H0542_001_0	1		1	05/27/2015	2016.01	05/27/2015 09:34:31 AM Pacific Daylight Time		05/26/2015 12:59:52 PM Pacific Daylight Time			05/27/2015 09:36:03 AM Pacific Daylight Time	ALTAMED HEALTH SERVICES CORPORATION	AltaMed Health Services Corporation	www.altamed.org	AltaMed Health Services Corporation (PACE)	08	20		1			H0542	001	0	2016	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	05/27/2015	2016.01	05/27/2015 09:34:38 AM Pacific Daylight Time		05/26/2015 01:01:10 PM Pacific Daylight Time			05/27/2015 09:36:03 AM Pacific Daylight Time	ALTAMED HEALTH SERVICES CORPORATION	AltaMed Health Services Corporation	www.altamed.org	AltaMed Health Services Corporation (PACE)	08	20		1			H0542	002	0	2016	Los Angeles County		2		2			2								http://www.altamed.org/	http://www.altamed.org/									(877)462-2582		(323)728-0411		(877)462-2582		(323)728-0411										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H0543	001	0	1	01	01	H0543_001_0	4		1	07/31/2015	2016.01	07/31/2015 09:56:46 AM Central Daylight Time	07/31/2015 01:02:11 PM Central Daylight Time	07/30/2015 06:35:11 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	001	0	2016	Los Angeles county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	004	0	1	01	01	H0543_004_0	3		1	07/31/2015	2016.01	07/31/2015 09:59:44 AM Central Daylight Time	07/31/2015 01:02:34 PM Central Daylight Time	07/30/2015 06:36:00 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Premier (HMO)	01	01		1			H0543	004	0	2016	Orange county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	007	0	1	01	01	H0543_007_0	3		1	07/31/2015	2016.01	07/31/2015 10:19:11 AM Central Daylight Time	07/31/2015 01:02:58 PM Central Daylight Time	07/30/2015 06:36:51 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	007	0	2016	Riverside and San Bernardino counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	013	0	1	01	01	H0543_013_0	3		1	08/03/2015	2016.01	08/03/2015 01:08:15 PM Central Daylight Time	08/03/2015 02:24:57 PM Central Daylight Time	07/30/2015 06:37:51 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Value (HMO)	01	01		1			H0543	013	0	2016	San Diego county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	019	0	1	01	01	H0543_019_0	3		1	07/31/2015	2016.01	07/31/2015 10:25:17 AM Central Daylight Time	07/31/2015 01:03:47 PM Central Daylight Time	07/30/2015 06:38:48 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	019	0	2016	Kern county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	022	0	1	01	01	H0543_022_0	3		1	07/31/2015	2016.01	07/31/2015 10:28:55 AM Central Daylight Time	07/31/2015 01:04:11 PM Central Daylight Time	07/30/2015 06:39:38 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	022	0	2016	Ventura county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	028	0	1	01	01	H0543_028_0	3		1	07/31/2015	2016.01	07/31/2015 10:30:57 AM Central Daylight Time	07/31/2015 01:04:35 PM Central Daylight Time	07/30/2015 06:40:22 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	028	0	2016	San Mateo county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	029	0	1	01	01	H0543_029_0	3		1	07/31/2015	2016.01	07/31/2015 10:35:01 AM Central Daylight Time	07/31/2015 01:05:00 PM Central Daylight Time	07/30/2015 06:41:06 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	029	0	2016	Santa Clara county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	032	0	1	01	01	H0543_032_0	3		1	07/31/2015	2016.01	07/31/2015 10:38:09 AM Central Daylight Time	07/31/2015 01:05:24 PM Central Daylight Time	07/30/2015 06:41:49 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	032	0	2016	Santa Barbara and San Luis Obispo counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	035	0	1	01	01	H0543_035_0	3		1	07/31/2015	2016.01	07/31/2015 10:39:10 AM Central Daylight Time	07/31/2015 01:05:49 PM Central Daylight Time	07/30/2015 06:42:34 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	035	0	2016	Fresno and Madera counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	036	0	1	01	01	H0543_036_0	3		1	07/31/2015	2016.01	07/31/2015 10:41:41 AM Central Daylight Time	07/31/2015 01:06:14 PM Central Daylight Time	07/30/2015 06:43:17 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	036	0	2016	Stanislaus county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	060	0	1	01	01	H0543_060_0	3		1	08/03/2015	2016.01	08/03/2015 11:38:04 AM Central Daylight Time	08/03/2015 02:26:03 PM Central Daylight Time	07/30/2015 06:44:00 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Premier (HMO)	01	01		1			H0543	060	0	2016	San Diego county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	070	0	1	01	01	H0543_070_0	3		1	08/03/2015	2016.01	08/03/2015 03:10:34 PM Central Daylight Time	07/31/2015 01:07:03 PM Central Daylight Time	07/30/2015 06:44:43 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	070	0	2016	Alameda and Contra Costa counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	086	0	1	01	01	H0543_086_0	3		1	05/29/2015	2016.01	05/29/2015 03:56:32 PM Central Daylight Time	07/31/2015 01:07:27 PM Central Daylight Time	07/30/2015 06:45:26 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	086	0	2016	Nevada county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	089	0	1	01	01	H0543_089_0	3		1	07/31/2015	2016.01	07/31/2015 10:47:50 AM Central Daylight Time	07/31/2015 01:15:36 PM Central Daylight Time	07/30/2015 06:46:09 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	089	0	2016	Placer, Sacramento, and Yolo counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	121	0	1	01	01	H0543_121_0	2		1	05/20/2015	2016.01	05/20/2015 10:55:01 AM Central Daylight Time	05/29/2015 03:04:47 PM Central Daylight Time				07/13/2015 01:40:50 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H0543	121	0	2016	Kern,LA,Orange,Riverside,San Bernardino,San Diego		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0543	138	0	1	01	01	H0543_138_0	3		1	07/31/2015	2016.01	07/31/2015 10:50:12 AM Central Daylight Time	07/31/2015 01:08:08 PM Central Daylight Time	07/30/2015 06:46:52 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	138	0	2016	Orange county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	140	0	1	01	01	H0543_140_0	3		1	07/31/2015	2016.01	07/31/2015 10:53:49 AM Central Daylight Time	07/31/2015 01:08:33 PM Central Daylight Time	07/30/2015 06:47:40 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	140	0	2016	Amador, El Dorado, Mendocino,Merced,Shasta,Tulare		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	144	0	1	01	01	H0543_144_0	4		1	07/31/2015	2016.01	07/31/2015 10:56:15 AM Central Daylight Time	07/31/2015 01:08:57 PM Central Daylight Time	07/30/2015 06:48:26 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	144	0	2016	Riverside and San Bernardino counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	145	0	1	01	01	H0543_145_0	3		1	07/31/2015	2016.01	07/31/2015 10:59:15 AM Central Daylight Time	07/31/2015 01:09:22 PM Central Daylight Time	07/30/2015 06:49:13 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	Sharp SecureHorizons Plan by UnitedHealthcare (HMO)	01	01		1			H0543	145	0	2016	San Diego county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	146	0	1	01	01	H0543_146_0	3		1	07/31/2015	2016.01	07/31/2015 11:00:59 AM Central Daylight Time	07/31/2015 01:09:46 PM Central Daylight Time	07/30/2015 06:50:01 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	146	0	2016	Placer, Sacramento, and Yolo counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	147	0	1	01	01	H0543_147_0	4		1	08/05/2015	2016.01	08/05/2015 12:12:47 PM Central Daylight Time	07/31/2015 01:10:11 PM Central Daylight Time	07/30/2015 06:50:48 AM Central Daylight Time			08/05/2015 03:19:59 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	147	0	2016	Stanislaus county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	148	0	1	01	01	H0543_148_0	4		1	07/31/2015	2016.01	07/31/2015 11:06:33 AM Central Daylight Time	07/31/2015 01:10:35 PM Central Daylight Time	07/30/2015 06:51:36 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	148	0	2016	Sonoma county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	151	0	1	01	01	H0543_151_0	3		1	07/31/2015	2016.01	07/31/2015 11:09:07 AM Central Daylight Time	07/31/2015 01:11:01 PM Central Daylight Time	07/30/2015 06:52:28 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	151	0	2016	Los Angeles county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	152	0	1	01	01	H0543_152_0	4		1	08/05/2015	2016.01	08/05/2015 12:17:00 PM Central Daylight Time	07/31/2015 01:11:25 PM Central Daylight Time	07/30/2015 06:53:18 AM Central Daylight Time			08/05/2015 03:19:59 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 4 (HMO)	01	01		1			H0543	152	0	2016	San Diego county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	153	0	1	01	01	H0543_153_0	6		1	08/07/2015	2016.01	08/07/2015 10:34:19 AM Central Daylight Time	07/31/2015 01:11:50 PM Central Daylight Time	07/30/2015 06:54:15 AM Central Daylight Time			08/07/2015 10:38:39 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 3 (HMO)	01	01		1			H0543	153	0	2016	Los Angeles, Orange, Riverside, and San Bernardino		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0543	802	0	1	01	01	H0543_802_0	2		1	05/19/2015	2016.01	05/19/2015 04:07:57 PM Central Daylight Time	05/29/2015 03:09:11 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	802	0	2016	CA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0543	805	0	1	01	01	H0543_805_0	1		1	04/13/2015	2016.01	04/13/2015 10:44:12 AM Central Daylight Time	05/29/2015 03:09:36 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	805	0	2016	CA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0543	806	0	1	01	01	H0543_806_0	1		1	04/13/2015	2016.01	04/13/2015 10:45:20 AM Central Daylight Time	05/29/2015 03:10:00 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	806	0	2016	CA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0544	002	0	1	01	01	H0544_002_0	10		1	08/03/2015	2016.01	08/03/2015 03:08:24 PM Pacific Daylight Time	08/04/2015 02:02:37 PM Pacific Daylight Time	07/29/2015 02:58:49 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H0544	002	0	2016	Los Angeles and Orange Counties (partial)		2	20719	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	003	0	1	01	01	H0544_003_0	6	2	1	08/03/2015	2016.01	08/03/2015 04:39:43 PM Pacific Daylight Time	08/04/2015 02:03:24 PM Pacific Daylight Time	07/29/2015 02:59:07 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Connect (HMO SNP)	01	01		1			H0544	003	0	2016	Los Angeles County (partial)		2	873	2			1	3		1	4			www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3146		(800)589-3146		(866)622-2820		(866)622-2820		(800)589-3146		(800)589-3146		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	004	0	1	01	01	H0544_004_0	7		1	08/03/2015	2016.01	08/03/2015 04:27:26 PM Pacific Daylight Time	08/04/2015 02:04:12 PM Pacific Daylight Time	07/29/2015 02:59:24 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Reliance (HMO SNP)	01	01		1			H0544	004	0	2016	Los Angeles and Orange Counties (partial)		2	8472	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3145		(800)589-3145		(866)622-2820		(866)622-2820		(800)589-3145		(800)589-3145		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	005	0	1	01	01	H0544_005_0	7		1	08/03/2015	2016.01	08/03/2015 04:16:57 PM Pacific Daylight Time	08/04/2015 02:03:48 PM Pacific Daylight Time	07/29/2015 02:59:42 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Touch (HMO SNP)	01	01		1			H0544	005	0	2016	Los Angeles and Orange Counties (partial)		2	1950	2			1	1	3	1				www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	007	0	1	01	01	H0544_007_0	7		1	08/03/2015	2016.01	08/03/2015 03:20:00 PM Pacific Daylight Time	08/04/2015 02:03:00 PM Pacific Daylight Time	07/29/2015 03:00:00 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore StartSmart Plus (HMO)	01	01		1			H0544	007	0	2016	L.A., Orange, San Bernardino Counties (partial)		2	1006	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	008	0	1	01	01	H0544_008_0	8		1	08/03/2015	2016.01	08/03/2015 03:23:14 PM Pacific Daylight Time	08/04/2015 02:07:23 PM Pacific Daylight Time	07/29/2015 03:00:17 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H0544	008	0	2016	San Bernardino County (partial)		2	1907	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	010	0	1	01	01	H0544_010_0	9		1	08/03/2015	2016.01	08/03/2015 05:52:46 PM Pacific Daylight Time	08/04/2015 02:07:47 PM Pacific Daylight Time	07/29/2015 03:00:35 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Reliance (HMO SNP)	01	01		1			H0544	010	0	2016	San Bernardino County (partial)		2	1452	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3145		(800)589-3145		(866)622-2820		(866)622-2820		(800)589-3145		(800)589-3145		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	012	0	1	01	01	H0544_012_0	7		1	08/03/2015	2016.01	08/03/2015 05:52:55 PM Pacific Daylight Time	08/04/2015 02:09:49 PM Pacific Daylight Time	07/29/2015 03:00:52 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H0544	012	0	2016	Santa Clara County (partial), San Benito County		2	1911	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	013	0	1	01	01	H0544_013_0	7		1	08/03/2015	2016.01	08/03/2015 04:27:59 PM Pacific Daylight Time	08/04/2015 02:05:00 PM Pacific Daylight Time	07/29/2015 03:01:10 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Heart (HMO SNP)	01	01		1			H0544	013	0	2016	Los Angeles and Orange Counties (partial)		2	1573	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	014	0	1	01	01	H0544_014_0	7		1	08/03/2015	2016.01	08/03/2015 04:28:22 PM Pacific Daylight Time	08/04/2015 02:04:36 PM Pacific Daylight Time	07/29/2015 03:01:28 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H0544	014	0	2016	Los Angeles and Orange Counties (partial)		2	1299	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	11a;	
H0544	015	0	1	01	01	H0544_015_0	8		1	08/03/2015	2016.01	08/03/2015 04:29:04 PM Pacific Daylight Time		07/29/2015 03:01:46 PM Pacific Daylight Time		08/03/2015 09:47:21 AM Pacific Daylight Time	08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore ESRD (HMO SNP)	01	01		1			H0544	015	0	2016	Los Angeles and Orange Counties (partial)		2	1149	2			1	4		1		00000000100000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4177		(888)357-4177		(866)622-2820		(866)622-2820		(888)357-4177		(888)357-4177		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	019	0	1	01	01	H0544_019_0	6		1	08/03/2015	2016.01	08/03/2015 05:53:03 PM Pacific Daylight Time	08/04/2015 02:08:10 PM Pacific Daylight Time	07/29/2015 03:02:04 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H0544	019	0	2016	San Bernardino County (partial)		2	439	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	020	0	1	01	01	H0544_020_0	6		1	08/03/2015	2016.01	08/03/2015 03:29:15 PM Pacific Daylight Time		07/29/2015 03:02:22 PM Pacific Daylight Time		08/03/2015 09:17:28 AM Pacific Daylight Time	08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore ESRD (HMO SNP)	01	01		1			H0544	020	0	2016	San Bernardino County (partial)		2	158	2			1	4		1		00000000100000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4177		(888)357-4177		(866)622-2820		(866)622-2820		(888)357-4177		(888)357-4177		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	021	0	1	01	01	H0544_021_0	7		1	08/03/2015	2016.01	08/03/2015 05:53:12 PM Pacific Daylight Time	08/04/2015 02:10:13 PM Pacific Daylight Time	07/29/2015 03:02:39 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore StartSmart Plus (HMO)	01	01		1			H0544	021	0	2016	Santa Clara (partial), Stanislaus, San Benito		2	682	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	024	0	1	01	01	H0544_024_0	7		1	08/03/2015	2016.01	08/03/2015 05:53:19 PM Pacific Daylight Time	08/04/2015 02:11:50 PM Pacific Daylight Time	07/29/2015 03:02:57 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H0544	024	0	2016	Santa Clara County (partial)		2	148	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	025	0	1	01	01	H0544_025_0	7		1	08/03/2015	2016.01	08/03/2015 05:53:28 PM Pacific Daylight Time	08/04/2015 02:11:26 PM Pacific Daylight Time	07/29/2015 03:03:14 PM Pacific Daylight Time			08/05/2015 09:47:14 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Diabetes (HMO SNP)	01	01		1			H0544	025	0	2016	Santa Clara County (partial)		2	712	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	027	0	1	01	01	H0544_027_0	6		1	08/03/2015	2016.01	08/03/2015 05:53:45 PM Pacific Daylight Time	08/04/2015 02:17:40 PM Pacific Daylight Time	07/29/2015 03:03:32 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H0544	027	0	2016	Stanislaus County		2	1534	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	031	0	1	01	01	H0544_031_0	6		1	08/04/2015	2016.01	08/04/2015 03:19:42 PM Pacific Daylight Time	08/04/2015 02:18:29 PM Pacific Daylight Time	07/29/2015 03:03:49 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H0544	031	0	2016	Stanislaus County		2	142	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	032	0	1	01	01	H0544_032_0	6		1	08/04/2015	2016.01	08/04/2015 03:19:33 PM Pacific Daylight Time	08/04/2015 02:18:04 PM Pacific Daylight Time	07/29/2015 03:04:07 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Diabetes (HMO SNP)	01	01		1			H0544	032	0	2016	Stanislaus County		2	739	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	036	0	1	01	01	H0544_036_0	6		1	08/03/2015	2016.01	08/03/2015 05:54:05 PM Pacific Daylight Time	08/04/2015 02:18:53 PM Pacific Daylight Time	07/29/2015 03:04:24 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore Heart (HMO SNP)	01	01		1			H0544	036	0	2016	Stanislaus County		2	100	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	037	0	1	01	01	H0544_037_0	6		1	08/03/2015	2016.01	08/03/2015 05:54:14 PM Pacific Daylight Time	08/04/2015 02:12:14 PM Pacific Daylight Time	07/29/2015 03:04:42 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore Heart (HMO SNP)	01	01		1			H0544	037	0	2016	Santa Clara County (partial)		2	138	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	038	0	1	01	01	H0544_038_0	5		1	08/03/2015	2016.01	08/03/2015 05:54:20 PM Pacific Daylight Time	08/04/2015 02:08:35 PM Pacific Daylight Time	07/29/2015 03:04:59 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore Heart (HMO SNP)	01	01		1			H0544	038	0	2016	San Bernardino County (partial)		2	257	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	041	0	1	01	01	H0544_041_0	5	2	1	08/03/2015	2016.01	08/03/2015 03:35:51 PM Pacific Daylight Time	08/04/2015 02:10:37 PM Pacific Daylight Time	07/29/2015 03:05:17 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Connect (HMO SNP)	01	01		1			H0544	041	0	2016	Santa Clara County (partial)		2	223	2			1	3		1	4			www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3146		(800)589-3146		(866)622-2820		(866)622-2820		(800)589-3146		(800)589-3146		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	049	0	1	01	01	H0544_049_0	5		1	07/07/2015	2016.01	07/07/2015 02:11:52 PM Pacific Daylight Time	08/04/2015 02:09:00 PM Pacific Daylight Time	07/29/2015 03:05:35 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Connect Plus (HMO)	01	01		1			H0544	049	0	2016	Counties: LA, Orange, San Bern., Stan, SC, San Ben		2	1800	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(888)426-5985		(888)426-5985		(866)622-2820		(866)622-2820		(888)426-5985		(888)426-5985		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	050	0	1	01	01	H0544_050_0	6		1	08/03/2015	2016.01	08/03/2015 05:54:28 PM Pacific Daylight Time	08/04/2015 02:11:02 PM Pacific Daylight Time	07/29/2015 03:05:53 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore Touch (HMO SNP)	01	01		1			H0544	050	0	2016	Santa Clara County (partial)		2	150	2			1	1	3	1				www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	801	0	1	01	01	H0544_801_0	2		1	05/19/2015	2016.01	05/19/2015 03:14:51 PM Pacific Daylight Time	05/29/2015 07:30:29 PM Pacific Daylight Time				05/30/2015 12:55:58 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore EGWP (HMO)	01	01		1			H0544	801	0	2016	California		1	48	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0544	802	0	1	01	01	H0544_802_0	5		1	05/19/2015	2016.01	05/19/2015 03:18:47 PM Pacific Daylight Time	05/29/2015 07:30:07 PM Pacific Daylight Time				05/30/2015 12:55:58 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H0544	802	0	2016	California		1	48	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	804	0	1	01	01	H0544_804_0	4		1	05/19/2015	2016.01	05/19/2015 03:17:28 PM Pacific Daylight Time	05/29/2015 07:30:52 PM Pacific Daylight Time				05/30/2015 12:55:58 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H0544	804	0	2016	California		1	12	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(855)295-7811		(855)295-7811		(866)622-2820		(866)622-2820		(855)295-7811		(855)295-7811		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0545	001	0	1	01	01	H0545_001_0	7		1	08/04/2015	2016.01	08/04/2015 03:18:01 PM Pacific Daylight Time	08/05/2015 02:04:15 PM Pacific Daylight Time	08/05/2015 02:03:39 PM Pacific Daylight Time			08/05/2015 02:19:09 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Service To Seniors (HMO)	01	01		1			H0545	001	0	2016	Counties: LA, RV and SB		2	16700	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		2					2					2	2			
H0545	012	0	1	01	01	H0545_012_0	8		1	07/13/2015	2016.01	07/13/2015 01:02:15 PM Pacific Daylight Time	08/05/2015 02:05:01 PM Pacific Daylight Time	08/05/2015 02:05:37 PM Pacific Daylight Time			08/05/2015 02:19:09 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Desert Preferred Choice (HMO)	01	01		1			H0545	012	0	2016	Riverside County		2	6900	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(800)251-8191		(866)756-4407		(866)756-4407		(800)523-3142		(800)523-3142		(866)756-4407		(866)756-4407		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		2					2					2	2			
H0545	013	0	1	01	01	H0545_013_0	9		1	08/04/2015	2016.01	08/04/2015 03:19:53 PM Pacific Daylight Time	08/05/2015 02:06:20 PM Pacific Daylight Time	08/05/2015 02:06:53 PM Pacific Daylight Time			08/05/2015 02:19:09 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan OC Preferred (HMO)	01	01		1			H0545	013	0	2016	Orange County		2	500	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		2					2					2	2			
H0545	801	0	1	01	01	H0545_801_0	2		1	05/18/2015	2016.01	05/18/2015 12:10:38 PM Pacific Daylight Time	06/01/2015 11:48:31 AM Pacific Daylight Time				06/01/2015 11:50:23 AM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Active Plus I (HMO)	01	01		1			H0545	801	0	2016	Counties: LA, OC, RV SB		1	500	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0545	802	0	1	01	01	H0545_802_0	2		1	05/18/2015	2016.01	05/18/2015 03:22:12 PM Pacific Daylight Time	06/01/2015 11:47:36 AM Pacific Daylight Time				06/01/2015 11:50:23 AM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Active Plus II (HMO)	01	01		1			H0545	802	0	2016	Counties: LA, OC, RV SB		1	500	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0562	009	0	1	01	01	H0562_009_0	3		1	07/10/2015	2016.01	07/10/2015 09:04:51 AM Pacific Daylight Time	08/03/2015 02:36:39 PM Pacific Daylight Time	08/03/2015 02:36:39 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	009	0	2016	San Francisco County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	012	0	1	01	01	H0562_012_0	3		1	08/03/2015	2016.01	08/03/2015 10:18:53 AM Pacific Daylight Time	08/03/2015 02:36:39 PM Pacific Daylight Time	08/03/2015 02:36:39 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	012	0	2016	San Diego County		2	2016	2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	039	0	1	01	01	H0562_039_0	4		1	07/10/2015	2016.01	07/10/2015 12:28:48 PM Pacific Daylight Time	08/03/2015 02:36:40 PM Pacific Daylight Time	08/03/2015 02:36:40 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	039	0	2016	Yolo county		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	044	0	1	01	01	H0562_044_0	2		1	07/09/2015	2016.01	07/09/2015 02:34:42 PM Pacific Daylight Time	07/14/2015 08:08:16 AM Pacific Daylight Time				07/14/2015 01:11:28 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Green (HMO)	01	01		1			H0562	044	0	2016	L.A., Riverside, S.Bern. Counties		2	2016	2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0562	045	0	1	01	01	H0562_045_0	2		1	07/10/2015	2016.01	07/10/2015 02:55:58 PM Pacific Daylight Time	07/14/2015 08:08:16 AM Pacific Daylight Time				07/14/2015 01:11:28 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Green (HMO)	01	01		1			H0562	045	0	2016	No. CA Counties		2	2016	2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0562	055	0	1	01	01	H0562_055_0	3	2	1	08/01/2015	2016.01	08/01/2015 06:57:31 PM Pacific Daylight Time	08/03/2015 02:36:41 PM Pacific Daylight Time	08/03/2015 02:36:41 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Amber I (HMO SNP)	01	01		1			H0562	055	0	2016	L.A., Kern, Orange, Riverside and San Bernardino		2		2			1	3		1	4			www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	068	0	1	01	01	H0562_068_0	3		1	07/10/2015	2016.01	07/10/2015 12:29:40 PM Pacific Daylight Time	08/03/2015 02:36:41 PM Pacific Daylight Time	08/03/2015 02:36:41 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	068	0	2016	Alameda and Stanislaus Counties		2	2016	2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	079	0	1	01	01	H0562_079_0	3		1	07/31/2015	2016.01	07/31/2015 04:31:06 PM Pacific Daylight Time	08/03/2015 02:36:42 PM Pacific Daylight Time	08/03/2015 02:36:42 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Ruby (HMO)	01	01		1			H0562	079	0	2016	Kern County, CA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	084	0	1	01	01	H0562_084_0	4		1	07/10/2015	2016.01	07/10/2015 12:41:37 PM Pacific Daylight Time	08/03/2015 02:36:42 PM Pacific Daylight Time	08/03/2015 02:36:42 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	084	0	2016	Placer, Sacramento Counties		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	090	0	1	01	01	H0562_090_0	3		1	08/03/2015	2016.01	08/03/2015 04:16:41 PM Pacific Daylight Time	08/03/2015 02:36:42 PM Pacific Daylight Time	08/03/2015 02:36:43 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	090	0	2016	Fresno County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	092	0	1	01	01	H0562_092_0	3		1	07/31/2015	2016.01	07/31/2015 06:16:04 PM Pacific Daylight Time	08/03/2015 02:36:43 PM Pacific Daylight Time	08/03/2015 02:36:43 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Jade (HMO SNP)	01	01		1			H0562	092	0	2016	Kern, L. A. and Orange Counties		2		2			1	4		1		00000000000000000010		www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	095	0	1	01	01	H0562_095_0	3		1	07/09/2015	2016.01	07/09/2015 02:34:12 PM Pacific Daylight Time	08/03/2015 02:36:43 PM Pacific Daylight Time	08/03/2015 02:36:44 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Ruby (HMO)	01	01		1			H0562	095	0	2016	Santa Clara County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	096	0	1	01	01	H0562_096_0	3		1	07/09/2015	2016.01	07/09/2015 03:23:40 PM Pacific Daylight Time	08/03/2015 02:36:44 PM Pacific Daylight Time	08/03/2015 02:36:45 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Ruby (HMO)	01	01		1			H0562	096	0	2016	Sonoma County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	097	0	1	01	01	H0562_097_0	3		1	07/30/2015	2016.01	07/30/2015 11:27:02 AM Pacific Daylight Time	08/03/2015 02:36:46 PM Pacific Daylight Time	08/03/2015 02:36:46 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0562	097	0	2016	San Francisco, CA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	100	1	1	01	01	H0562_100_1	4		1	07/10/2015	2016.01	07/10/2015 12:44:16 PM Pacific Daylight Time	08/03/2015 02:36:47 PM Pacific Daylight Time	08/03/2015 02:36:47 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	100	1	2016	LA, Orange, Riverside and San Bernardino Counties	Los Angeles and Orange Counties	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	100	2	1	01	01	H0562_100_2	3		1	07/10/2015	2016.01	08/03/2015 04:34:15 PM Pacific Daylight Time	08/03/2015 02:36:48 PM Pacific Daylight Time	08/03/2015 02:36:48 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	100	2	2016	LA, Orange, Riverside and San Bernardino Counties	Riverside and San Bernardino Counties	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	101	1	1	01	01	H0562_101_1	3		1	07/31/2015	2016.01	07/31/2015 05:49:34 PM Pacific Daylight Time	08/03/2015 02:36:49 PM Pacific Daylight Time	08/03/2015 02:36:49 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Gold Select (HMO)	01	01		1			H0562	101	1	2016	LA, Orange, Riverside and San Bernardino Counties	Los Angeles and Orange Counties	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	101	2	1	01	01	H0562_101_2	3		1	07/31/2015	2016.01	08/03/2015 04:34:37 PM Pacific Daylight Time	08/03/2015 02:36:49 PM Pacific Daylight Time	08/03/2015 02:36:50 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Gold Select (HMO)	01	01		1			H0562	101	2	2016	LA, Orange, Riverside and San Bernardino Counties	Riverside and San Bernardino Counties	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	102	0	1	01	01	H0562_102_0	3		1	07/31/2015	2016.01	07/31/2015 05:49:12 PM Pacific Daylight Time	08/03/2015 02:36:50 PM Pacific Daylight Time	08/03/2015 02:36:50 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0562	102	0	2016	Placer and Sacramento Counties, CA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	103	0	1	01	01	H0562_103_0	3		1	07/31/2015	2016.01	07/31/2015 04:41:19 PM Pacific Daylight Time	08/03/2015 02:36:51 PM Pacific Daylight Time	08/03/2015 02:36:51 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0562	103	0	2016	Yolo County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	110	1	1	01	01	H0562_110_1	3	2	1	07/31/2015	2016.01	07/31/2015 04:49:21 PM Pacific Daylight Time	08/03/2015 02:36:51 PM Pacific Daylight Time	08/03/2015 02:36:52 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Amber II (HMO SNP)	01	01		1			H0562	110	1	2016	Parts of Southern and Northern California	Fresno, L.A., Orange, S.D., San Francisco	2		2			1	3		1	4			www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	110	2	1	01	01	H0562_110_2	3	2	1	07/31/2015	2016.01	08/03/2015 04:35:07 PM Pacific Daylight Time	08/03/2015 02:36:52 PM Pacific Daylight Time	08/03/2015 02:36:52 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Amber II (HMO SNP)	01	01		1			H0562	110	2	2016	Parts of Southern and Northern California	Kern, Riverside and San Bernardino, Tulare	2		2			1	3		1	4			www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	111	1	1	01	01	H0562_111_1	4		1	07/31/2015	2016.01	07/31/2015 04:48:34 PM Pacific Daylight Time	08/03/2015 02:36:52 PM Pacific Daylight Time	08/03/2015 02:36:53 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Sapphire (HMO)	01	01		1			H0562	111	1	2016	Parts of Southern, Northern and Central CA	L.A., Orange and San Diego, CA	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	111	2	1	01	01	H0562_111_2	4		1	08/03/2015	2016.01	08/03/2015 11:23:43 AM Pacific Daylight Time	08/03/2015 02:36:53 PM Pacific Daylight Time	08/03/2015 02:36:39 PM Pacific Daylight Time			08/03/2015 05:45:39 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Sapphire (HMO)	01	01		1			H0562	111	2	2016	Parts of Southern, Northern and Central CA	Kern, Riverside and San Bernardino, CA	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0562	801	0	1	01	01	H0562_801_0	1		1	06/01/2015	2016.01	06/01/2015 10:01:46 AM Pacific Daylight Time	05/28/2015 03:11:22 PM Pacific Daylight Time				06/01/2015 10:22:42 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	801	0	2016	California		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0562	803	0	1	01	01	H0562_803_0	1		1	04/15/2015	2016.01	04/15/2015 03:00:51 PM US Mountain Standard Time	05/28/2015 03:11:23 PM Pacific Daylight Time				06/01/2015 10:22:42 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	803	0	2016	California		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0562	804	0	1	01	01	H0562_804_0	1		1	04/15/2015	2016.01	04/15/2015 03:01:29 PM US Mountain Standard Time	05/28/2015 03:11:25 PM Pacific Daylight Time				06/01/2015 10:22:42 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	804	0	2016	California		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H0564	055	0	1	01	01	H0564_055_0	9	2	1	08/03/2015	2016.01	08/03/2015 12:59:08 PM Pacific Daylight Time	08/04/2015 07:27:37 AM Pacific Daylight Time	07/30/2015 04:25:49 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H0564	055	0	2016	Fresno County		2	648	2			1	3		1	5				www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	056	0	1	01	01	H0564_056_0	8	2	1	07/06/2015	2016.01	07/06/2015 10:16:22 AM Pacific Daylight Time	08/01/2015 06:06:59 PM Pacific Daylight Time	07/30/2015 04:26:35 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H0564	056	0	2016	Kern County		2	422	2			1	3		1	5				www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	058	0	1	01	01	H0564_058_0	8	2	1	08/03/2015	2016.01	08/03/2015 10:49:55 AM Pacific Daylight Time	08/04/2015 07:28:17 AM Pacific Daylight Time	07/30/2015 04:27:23 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H0564	058	0	2016	San Francisco County		2	896	2			1	3		1	5				www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	059	0	1	01	01	H0564_059_0	9	2	1	07/06/2015	2016.01	07/06/2015 10:17:23 AM Pacific Daylight Time	08/04/2015 07:28:53 AM Pacific Daylight Time	07/30/2015 04:28:06 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H0564	059	0	2016	Ventura County		2	361	2			1	3		1	5				www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	060	0	1	01	01	H0564_060_0	10		1	08/02/2015	2016.01	08/02/2015 12:47:34 PM Pacific Daylight Time	08/02/2015 02:01:57 PM Pacific Daylight Time	07/30/2015 03:24:30 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	060	0	2016	Fresno County		2	478	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	061	0	1	01	01	H0564_061_0	11		1	08/01/2015	2016.01	08/01/2015 03:39:21 AM Pacific Daylight Time	08/01/2015 06:08:42 PM Pacific Daylight Time	07/30/2015 03:25:11 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	061	0	2016	San Francisco County		2	688	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	062	0	1	01	01	H0564_062_0	11		1	08/01/2015	2016.01	08/01/2015 03:32:49 AM Pacific Daylight Time	08/01/2015 06:09:16 PM Pacific Daylight Time	07/30/2015 03:25:51 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Select (HMO)	01	01		1			H0564	062	0	2016	Los Angeles County		2	3320	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	063	0	1	01	01	H0564_063_0	11		1	08/01/2015	2016.01	08/01/2015 03:33:39 AM Pacific Daylight Time	08/04/2015 05:05:43 PM Pacific Daylight Time	07/30/2015 03:26:30 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Select (HMO)	01	01		1			H0564	063	0	2016	Orange County		2	1094	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	067	1	1	01	01	H0564_067_1	10		1	08/01/2015	2016.01	08/01/2015 03:38:31 AM Pacific Daylight Time	08/01/2015 06:10:24 PM Pacific Daylight Time	07/30/2015 03:03:43 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	067	1	2016	San Bernardino and Riverside Counties	San Bernardino County	2	482	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	067	2	1	01	01	H0564_067_2	10		1	08/01/2015	2016.01	08/01/2015 03:36:14 AM Pacific Daylight Time	08/01/2015 06:10:56 PM Pacific Daylight Time	07/30/2015 03:04:31 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	067	2	2016	San Bernardino and Riverside Counties	Riverside County	2	649	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	068	0	1	01	01	H0564_068_0	11		1	08/01/2015	2016.01	08/01/2015 03:36:57 AM Pacific Daylight Time	08/04/2015 05:06:18 PM Pacific Daylight Time	07/30/2015 03:02:46 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	068	0	2016	Orange and Los Angeles Counties		2	2637	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	069	0	1	01	01	H0564_069_0	10		1	08/01/2015	2016.01	08/01/2015 03:37:59 AM Pacific Daylight Time	08/04/2015 05:06:52 PM Pacific Daylight Time	07/30/2015 03:05:13 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	069	0	2016	Kern County		2	1568	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	070	0	1	01	01	H0564_070_0	10		1	08/01/2015	2016.01	08/01/2015 03:40:25 AM Pacific Daylight Time	08/01/2015 06:12:43 PM Pacific Daylight Time	07/30/2015 03:20:42 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	070	0	2016	Ventura County		2	1132	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	071	0	1	01	01	H0564_071_0	10		1	08/02/2015	2016.01	08/02/2015 12:46:59 PM Pacific Daylight Time	08/02/2015 02:02:29 PM Pacific Daylight Time	07/30/2015 03:28:23 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	071	0	2016	Sacramento		2	871	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	072	0	1	01	01	H0564_072_0	10		1	08/01/2015	2016.01	08/01/2015 03:43:35 AM Pacific Daylight Time	08/01/2015 06:13:17 PM Pacific Daylight Time	07/30/2015 03:28:59 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	072	0	2016	San Diego		2	1306	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	074	0	1	01	01	H0564_074_0	10		1	08/01/2015	2016.01	08/01/2015 03:45:03 AM Pacific Daylight Time	08/01/2015 06:13:50 PM Pacific Daylight Time	07/30/2015 03:30:16 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H0564	074	0	2016	Yolo		2	239	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	076	0	1	01	01	H0564_076_0	11		1	08/01/2015	2016.01	08/01/2015 03:46:04 AM Pacific Daylight Time	08/01/2015 06:14:22 PM Pacific Daylight Time	07/30/2015 03:30:55 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Select (HMO)	01	01		1			H0564	076	0	2016	San Bernardino		2	875	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	077	0	1	01	01	H0564_077_0	10		1	08/01/2015	2016.01	08/01/2015 03:46:37 AM Pacific Daylight Time	08/01/2015 06:14:55 PM Pacific Daylight Time	07/30/2015 03:31:31 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Select (HMO)	01	01		1			H0564	077	0	2016	Riverside		2	1211	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	078	0	1	01	01	H0564_078_0	9		1	07/16/2015	2016.01	07/16/2015 11:39:47 AM Pacific Daylight Time	08/04/2015 07:29:31 AM Pacific Daylight Time	07/30/2015 04:41:40 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0564	078	0	2016	San Diego		2	211	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	079	0	1	01	01	H0564_079_0	9		1	07/06/2015	2016.01	07/06/2015 10:54:35 AM Pacific Daylight Time	08/04/2015 07:30:09 AM Pacific Daylight Time	07/30/2015 04:42:22 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0564	079	0	2016	Riverside and San Bernardino		2	421	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	080	0	1	01	01	H0564_080_0	9		1	07/06/2015	2016.01	07/06/2015 10:54:45 AM Pacific Daylight Time	08/04/2015 07:30:55 AM Pacific Daylight Time	07/30/2015 04:40:59 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H0564	080	0	2016	Los Angeles and Orange		2	632	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0564	801	0	1	01	01	H0564_801_0	4		1	05/30/2015	2016.01	05/30/2015 07:19:11 PM Pacific Daylight Time	05/31/2015 03:22:51 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		1			H0564	801	0	2016	California, Select Counties		1	542	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831		(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14d;14e;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;14d;14e;18a;	1					1	2			
H0564	810	0	1	01	01	H0564_810_0	3		1	05/20/2015	2016.01	05/20/2015 02:01:46 PM Pacific Daylight Time	05/31/2015 03:03:15 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		1			H0564	810	0	2016	California, Select Counties		1	50	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14d;14e;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;14d;14e;18a;	1					1	2			
H0571	001	0	1	01	01	H0571_001_0	4		1	07/02/2015	2016.01	07/02/2015 08:04:52 AM Pacific Daylight Time	08/04/2015 09:29:08 AM Pacific Daylight Time	07/29/2015 01:57:26 PM Pacific Daylight Time			08/04/2015 03:57:16 PM Pacific Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphealthplan.com/medicare	CCHP Senior Program  (HMO)	01	01		1			H0571	001	0	2016	San Francisco and Northern San Mateo counties		2	4007	2			2								www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d	www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d	(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8800	3282	(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8800	3282	(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		2					2					2	1	01	9a;9b;	
H0571	005	0	1	01	01	H0571_005_0	3	2	1	06/25/2015	2016.01	06/25/2015 12:37:29 PM Pacific Daylight Time	08/04/2015 09:29:28 AM Pacific Daylight Time	07/29/2015 02:00:25 PM Pacific Daylight Time			08/04/2015 03:57:16 PM Pacific Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphealthplan.com/medicare	CCHP Senior Select Program (HMO SNP)	01	01		1			H0571	005	0	2016	San Francisco County		2	4436	2			1	3		1	2				www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d	www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d	(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8800	3282	(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8800	3282	(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		2					2					2	2			
H0602	001	0	1	18	06	H0602_001_0	6		1	07/14/2015	2016.01	07/14/2015 04:23:22 PM Mountain Daylight Time					07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan (Cost)	06	18		1			H0602	001	0	2016	Western Slope Colorado		2	1450	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	003	0	1	18	06	H0602_003_0	6		1	07/14/2015	2016.01	07/14/2015 04:23:35 PM Mountain Daylight Time					07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Plus Plan (Cost)	06	18		1			H0602	003	0	2016	Colorado		2	50	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	007	0	1	18	06	H0602_007_0	6		1	07/14/2015	2016.01	07/14/2015 04:23:48 PM Mountain Daylight Time					07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan (Cost)	06	18		1			H0602	007	0	2016	Front Range Colorado		2	400	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	009	0	1	18	06	H0602_009_0	6		1	07/14/2015	2016.01	07/14/2015 04:24:01 PM Mountain Daylight Time					07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan (Cost)	06	18		1			H0602	009	0	2016	Denver Metro/Boulder Colorado		2	350	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	017	0	1	18	06	H0602_017_0	6		1	07/14/2015	2016.01	07/14/2015 04:24:16 PM Mountain Daylight Time		05/31/2015 05:42:03 PM Mountain Daylight Time			07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan + Rx (Cost)	06	18		1			H0602	017	0	2016	Western Slope Colorado		2	5250	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0602	019	0	1	18	06	H0602_019_0	7		1	07/14/2015	2016.01	07/14/2015 04:24:30 PM Mountain Daylight Time		05/31/2015 05:42:04 PM Mountain Daylight Time			07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Plus Plan + Rx (Cost)	06	18		1			H0602	019	0	2016	Colorado		2	900	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0602	020	0	1	18	06	H0602_020_0	6		1	07/14/2015	2016.01	07/14/2015 04:24:42 PM Mountain Daylight Time		05/31/2015 05:42:04 PM Mountain Daylight Time			07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan + Rx (Cost)	06	18		1			H0602	020	0	2016	Front Range Colorado		2	1400	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0602	022	0	1	18	06	H0602_022_0	6		1	07/14/2015	2016.01	07/14/2015 04:24:55 PM Mountain Daylight Time		05/31/2015 05:42:05 PM Mountain Daylight Time			07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan + Rx (Cost)	06	18		1			H0602	022	0	2016	Denver Metro/Boulder Colorado		2	1450	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0602	026	0	1	18	06	H0602_026_0	4		1	06/01/2015	2016.01	06/01/2015 03:23:06 PM Mountain Daylight Time					06/01/2015 05:25:59 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	AB Basic Plan (Cost)	06	18		1			H0602	026	0	2016	Colorado		2	1150	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										1	1	5;7d;7e;7h;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;15;16b;	2		2					2	2			
H0602	027	0	1	18	06	H0602_027_0	6		1	07/14/2015	2016.01	07/14/2015 04:25:10 PM Mountain Daylight Time					07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Thrifty Plan (Cost)	06	18		1			H0602	027	0	2016	Colorado		2	900	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	039	0	1	18	06	H0602_039_0	6		1	07/14/2015	2016.01	07/14/2015 04:25:51 PM Mountain Daylight Time		05/31/2015 05:42:05 PM Mountain Daylight Time			07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Thrifty Plan + Rx (Cost)	06	18		1			H0602	039	0	2016	Colorado		2	1450	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0602	040	0	2	18	06	H0602_040_0	4		1	06/01/2015	2016.01	06/01/2015 03:45:08 PM Mountain Daylight Time					06/01/2015 05:25:59 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	B Basic Plan (Cost)	06	18		2	2		H0602	040	0	2016	Colorado		2	15	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										1	1	5;7d;7e;7h;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;15;16b;	2		2					2	2			
H0602	041	0	2	18	06	H0602_041_0	6		1	07/14/2015	2016.01	07/14/2015 04:25:38 PM Mountain Daylight Time					07/14/2015 05:15:26 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	B Standard Plan (Cost)	06	18		2	2		H0602	041	0	2016	Colorado		2	15	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	042	0	1	18	06	H0602_042_0	7		1	07/14/2015	2016.01	07/14/2015 05:11:27 PM Mountain Daylight Time					07/17/2015 08:31:28 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Green Plan (Cost)	06	18		1			H0602	042	0	2016	Colorado		2	2050	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0602	043	0	1	18	06	H0602_043_0	7		1	07/14/2015	2016.01	07/14/2015 05:11:44 PM Mountain Daylight Time		05/31/2015 05:42:02 PM Mountain Daylight Time			07/17/2015 08:31:28 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Green Plan + Rx (Cost)	06	18		1			H0602	043	0	2016	Colorado		2	2900	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0602	801	0	1	18	06	H0602_801_0	5		1	06/01/2015	2016.01	06/01/2015 06:08:54 PM Mountain Daylight Time					06/01/2015 06:32:48 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Group Plus Plan (Cost)	06	18		1			H0602	801	0	2016	Colorado		1	150	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-													2			
H0602	804	0	1	18	06	H0602_804_0	2		1	06/01/2015	2016.01	06/01/2015 06:30:47 PM Mountain Daylight Time					06/01/2015 06:32:48 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Colorado PERACARE (Cost)	06	18		1			H0602	804	0	2016	Colorado		1	4400	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)281-0720		(888)281-0720		(888)281-0720		(888)281-0720		(888)281-0720		(888)281-0720		(888)281-0720		(888)281-0720		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-													2			
H0609	002	0	1	01	01	H0609_002_0	4		1	07/31/2015	2016.01	07/31/2015 12:13:20 PM Central Daylight Time	07/31/2015 12:44:17 PM Central Daylight Time	07/30/2015 06:59:45 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0609	002	0	2016	El Paso, Fremont, Larimer, Pueblo, Teller, Weld		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	007	0	1	01	01	H0609_007_0	3		1	07/31/2015	2016.01	07/31/2015 12:13:06 PM Central Daylight Time	07/31/2015 12:44:42 PM Central Daylight Time	07/30/2015 07:00:29 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0609	007	0	2016	Denver Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	012	0	1	01	01	H0609_012_0	3		1	07/31/2015	2016.01	07/31/2015 12:16:45 PM Central Daylight Time	07/31/2015 12:45:07 PM Central Daylight Time	07/30/2015 07:01:15 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0609	012	0	2016	Denver Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	015	0	1	01	01	H0609_015_0	2		1	05/20/2015	2016.01	05/20/2015 04:57:09 PM Central Daylight Time	05/29/2015 03:12:26 PM Central Daylight Time				07/13/2015 01:40:50 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H0609	015	0	2016	El Paso, Fremont, Larimer, Pueblo, Teller, Weld		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0609	018	0	1	01	01	H0609_018_0	2		1	05/20/2015	2016.01	05/20/2015 12:47:09 PM Central Daylight Time	05/29/2015 03:12:50 PM Central Daylight Time				07/13/2015 01:40:50 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H0609	018	0	2016	Denver Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0609	020	0	1	01	01	H0609_020_0	4		1	07/31/2015	2016.01	07/31/2015 12:20:08 PM Central Daylight Time	07/31/2015 12:45:32 PM Central Daylight Time	07/30/2015 07:02:06 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0609	020	0	2016	El Paso, Fremont, Larimer, Pueblo, Teller, Weld		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	025	0	1	01	01	H0609_025_0	3		1	07/31/2015	2016.01	07/31/2015 11:50:38 AM Central Daylight Time	07/31/2015 12:45:57 PM Central Daylight Time	07/30/2015 07:02:53 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H0609	025	0	2016	Pima County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	026	0	1	01	01	H0609_026_0	3		1	07/31/2015	2016.01	07/31/2015 11:57:01 AM Central Daylight Time	07/31/2015 12:46:22 PM Central Daylight Time	07/30/2015 07:03:42 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0609	026	0	2016	Maricopa and Pinal Counties		2		2			2							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	027	0	1	01	01	H0609_027_0	3		1	07/31/2015	2016.01	07/31/2015 11:57:41 AM Central Daylight Time	07/31/2015 12:46:47 PM Central Daylight Time	07/30/2015 07:04:29 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H0609	027	0	2016	Maricopa and Pinal Counties		2		2			2							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	028	0	1	01	01	H0609_028_0	3		1	07/31/2015	2016.01	07/31/2015 09:27:58 AM Central Daylight Time	07/31/2015 12:47:12 PM Central Daylight Time	07/30/2015 07:05:17 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H0609	028	0	2016	Clark County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	801	0	1	01	01	H0609_801_0	1		1	04/13/2015	2016.01	04/13/2015 10:51:32 AM Central Daylight Time	05/29/2015 03:15:14 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	801	0	2016	CO Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0609	804	0	1	01	01	H0609_804_0	1		1	04/13/2015	2016.01	04/13/2015 10:53:41 AM Central Daylight Time	05/29/2015 03:15:39 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	804	0	2016	CO Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0609	805	0	1	01	01	H0609_805_0	1		1	04/13/2015	2016.01	04/13/2015 10:56:25 AM Central Daylight Time	05/29/2015 03:16:04 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	805	0	2016	CO Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0609	806	0	2	01	01	H0609_806_0	1		1	04/13/2015	2016.01	04/13/2015 11:00:39 AM Central Daylight Time	05/29/2015 03:16:28 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H0609	806	0	2016	CO Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0609	807	0	1	01	01	H0609_807_0	2		1	06/01/2015	2016.01	06/01/2015 02:45:26 PM Central Daylight Time	05/29/2015 03:16:53 PM Central Daylight Time				06/01/2015 02:49:49 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	807	0	2016	Arizona		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0609	808	0	1	01	01	H0609_808_0	2		1	06/01/2015	2016.01	06/01/2015 02:45:45 PM Central Daylight Time	05/29/2015 03:17:18 PM Central Daylight Time				06/01/2015 02:49:49 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	808	0	2016	Arizona		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0609	809	0	1	01	01	H0609_809_0	2		1	06/01/2015	2016.01	06/01/2015 02:46:07 PM Central Daylight Time	05/29/2015 03:17:43 PM Central Daylight Time				06/01/2015 02:49:49 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	809	0	2016	Arizona		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0609	810	0	1	01	01	H0609_810_0	1		1	04/23/2015	2016.01	04/23/2015 02:03:14 PM Central Daylight Time	05/29/2015 03:18:08 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	810	0	2016	Nevada		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0609	811	0	1	01	01	H0609_811_0	1		1	04/23/2015	2016.01	04/23/2015 02:03:50 PM Central Daylight Time	05/29/2015 03:18:32 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	811	0	2016	Clark and Nye counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0609	812	0	1	01	01	H0609_812_0	1		1	04/23/2015	2016.01	04/23/2015 02:04:27 PM Central Daylight Time	05/29/2015 03:18:57 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	812	0	2016	Clark and Nye counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H0613	001	0	1	20	08	H0613_001_0	1		1	05/26/2015	2016.01	05/26/2015 01:39:46 PM Mountain Daylight Time		05/18/2015 10:31:28 AM Mountain Daylight Time			05/26/2015 01:56:20 PM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	Total Longterm Care, Inc.	www.PACEMyInnovAge.org	Total Longterm Care - Dual eligibles (PACE)	08	20		1			H0613	001	0	2016	Metropolitan Denver		2		2			2								http://www.totallongtermcare.org	http://www.pharmerica.com									(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664										(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664																
H0613	003	0	1	20	08	H0613_003_0	1		1	05/26/2015	2016.01	05/26/2015 01:40:09 PM Mountain Daylight Time		05/18/2015 10:38:07 AM Mountain Daylight Time			05/26/2015 01:56:20 PM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	Total Longterm Care, Inc.	www.PACEMyInnovAge.org	Total Longterm Care - Medicare only (PACE)	08	20		1			H0613	003	0	2016	Metropolitian Denver		2		2			2								http://www.totallongtermcare.org	http://www.pharmerica.com									(303)869-4664		(303)869-4664		(877)277-6163		(303)869-4664										(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664																
H0624	001	0	1	01	01	H0624_001_0	3	2	1	05/26/2015	2016.01	05/26/2015 08:21:10 AM Central Daylight Time	07/31/2015 01:10:41 PM Central Daylight Time	07/30/2015 07:06:17 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0624	001	0	2016	Denver and Colorado Springs metro areas		2		2			1	3		1	4			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	013	0	1	01	01	H0630_013_0	11		1	08/04/2015	2016.01	08/04/2015 02:43:16 PM Mountain Daylight Time	08/04/2015 08:50:11 AM Mountain Daylight Time	08/04/2015 08:29:30 AM Mountain Daylight Time			08/04/2015 02:57:14 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	01	01		1			H0630	013	0	2016	Denver Metro Area		2	24314	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	014	0	1	01	01	H0630_014_0	10	2	1	07/15/2015	2016.01	07/15/2015 11:37:13 AM Mountain Daylight Time	08/04/2015 08:50:34 AM Mountain Daylight Time	08/04/2015 08:30:12 AM Mountain Daylight Time			08/04/2015 02:57:14 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid (HMO SNP)	01	01		1			H0630	014	0	2016	Denver Metro Area		2	2539	2			1	3		1	4			kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	015	0	1	01	01	H0630_015_0	11		1	08/04/2015	2016.01	08/04/2015 02:43:25 PM Mountain Daylight Time	08/04/2015 08:50:58 AM Mountain Daylight Time	08/04/2015 08:30:53 AM Mountain Daylight Time			08/04/2015 02:57:14 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	01	01		1			H0630	015	0	2016	Denver Metro Area		2	32770	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	016	0	1	01	01	H0630_016_0	12		1	07/10/2015	2016.01	07/10/2015 10:14:43 AM Mountain Daylight Time	08/04/2015 08:51:22 AM Mountain Daylight Time	08/04/2015 08:31:34 AM Mountain Daylight Time			08/04/2015 02:57:14 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Gold (HMO)	01	01		1			H0630	016	0	2016	Denver Metro Area		2	3403	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	017	0	1	01	01	H0630_017_0	11		1	08/03/2015	2016.01	08/03/2015 01:45:18 PM Mountain Daylight Time	08/04/2015 08:51:46 AM Mountain Daylight Time	08/04/2015 08:32:16 AM Mountain Daylight Time			08/04/2015 02:57:14 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	01	01		1			H0630	017	0	2016	Southern Colorado		2	5413	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	018	0	1	01	01	H0630_018_0	11		1	07/10/2015	2016.01	07/10/2015 10:15:43 AM Mountain Daylight Time	08/04/2015 08:52:11 AM Mountain Daylight Time	08/04/2015 08:32:58 AM Mountain Daylight Time			08/04/2015 02:57:14 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	01	01		1			H0630	018	0	2016	Southern Colorado		2	2184	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	020	0	1	01	01	H0630_020_0	11		1	08/03/2015	2016.01	08/03/2015 01:45:27 PM Mountain Daylight Time	08/04/2015 08:52:35 AM Mountain Daylight Time	08/04/2015 08:33:40 AM Mountain Daylight Time			08/04/2015 02:57:14 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	01	01		1			H0630	020	0	2016	Northern Colorado		2	2398	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	021	0	1	01	01	H0630_021_0	12		1	07/10/2015	2016.01	07/10/2015 10:16:38 AM Mountain Daylight Time	08/04/2015 08:52:59 AM Mountain Daylight Time	08/04/2015 08:34:23 AM Mountain Daylight Time			08/04/2015 02:57:14 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	01	01		1			H0630	021	0	2016	Northern Colorado		2	1896	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0630	805	0	2	01	01	H0630_805_0	8		1	05/29/2015	2016.01	05/29/2015 12:45:31 PM Mountain Daylight Time	07/16/2015 11:30:22 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD_Part B only (HMO)	01	01		2	1		H0630	805	0	2016	Denver Metro Area		1	791	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	806	0	2	01	01	H0630_806_0	8		1	05/29/2015	2016.01	05/29/2015 12:53:08 PM Mountain Daylight Time	07/16/2015 11:30:45 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA only_Part B only (HMO)	01	01		2	1		H0630	806	0	2016	Denver Metro Area		1	0	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	807	0	1	01	01	H0630_807_0	8		1	05/29/2015	2016.01	05/29/2015 12:53:16 PM Mountain Daylight Time	07/16/2015 11:31:07 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD (HMO)	01	01		1			H0630	807	0	2016	Denver Metro Area		1	22610	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	808	0	1	01	01	H0630_808_0	8		1	05/29/2015	2016.01	05/29/2015 12:53:25 PM Mountain Daylight Time	07/16/2015 11:31:30 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Adv_Group_MA only (HMO)	01	01		1			H0630	808	0	2016	Denver Metro Area		1	4	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	809	0	2	01	01	H0630_809_0	8		1	05/29/2015	2016.01	05/29/2015 12:53:36 PM Mountain Daylight Time	07/16/2015 11:31:52 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB B only with D (HMO)	01	01		2	1		H0630	809	0	2016	Denver Metro Area		1	8	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	810	0	1	01	01	H0630_810_0	8		1	05/29/2015	2016.01	05/29/2015 12:49:12 PM Mountain Daylight Time	07/16/2015 11:32:14 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	810	0	2016	Denver Metro Area		1	2702	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	811	0	2	01	01	H0630_811_0	10		1	05/29/2015	2016.01	05/29/2015 12:54:14 PM Mountain Daylight Time	07/16/2015 11:32:37 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD_Part B only (HMO)	01	01		2	1		H0630	811	0	2016	Southern Colorado		1	134	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	812	0	2	01	01	H0630_812_0	10		1	05/29/2015	2016.01	05/29/2015 12:54:24 PM Mountain Daylight Time	07/16/2015 11:32:59 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA only_Part B only (HMO)	01	01		2	1		H0630	812	0	2016	Southern Colorado		1	0	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	813	0	1	01	01	H0630_813_0	10		1	05/29/2015	2016.01	05/29/2015 12:54:35 PM Mountain Daylight Time	07/16/2015 11:33:22 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD (HMO)	01	01		1			H0630	813	0	2016	Southern Colorado		1	2706	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	814	0	1	01	01	H0630_814_0	10		1	05/29/2015	2016.01	05/29/2015 12:54:48 PM Mountain Daylight Time	07/16/2015 11:33:45 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Adv Group_MA only (HMO)	01	01		1			H0630	814	0	2016	Southern Colorado		1	0	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	815	0	2	01	01	H0630_815_0	10		1	05/29/2015	2016.01	05/29/2015 12:55:08 PM Mountain Daylight Time	07/16/2015 11:34:07 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB B only with D (HMO)	01	01		2	1		H0630	815	0	2016	Southern Colorado		1	0	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	816	0	1	01	01	H0630_816_0	10		1	05/29/2015	2016.01	05/29/2015 12:55:18 PM Mountain Daylight Time	07/16/2015 11:34:29 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	816	0	2016	Southern Colorado		1	238	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	817	0	2	01	01	H0630_817_0	8		1	05/29/2015	2016.01	05/29/2015 12:55:26 PM Mountain Daylight Time	07/16/2015 11:34:51 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MAPD Part B Only (HMO)	01	01		2	1		H0630	817	0	2016	Northern Colorado		1	23	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	818	0	2	01	01	H0630_818_0	8		1	05/29/2015	2016.01	05/29/2015 12:55:39 PM Mountain Daylight Time	07/16/2015 11:35:14 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA Only Part B Only (HMO)	01	01		2	1		H0630	818	0	2016	Northern Colorado		1	0	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	819	0	1	01	01	H0630_819_0	10		1	05/29/2015	2016.01	05/29/2015 12:55:52 PM Mountain Daylight Time	07/16/2015 11:35:36 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MAPD (HMO)	01	01		1			H0630	819	0	2016	Northern Colorado		1	719	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	820	0	1	01	01	H0630_820_0	8		1	05/29/2015	2016.01	05/29/2015 12:56:00 PM Mountain Daylight Time	07/16/2015 11:35:59 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA Only (HMO)	01	01		1			H0630	820	0	2016	Northern Colorado		1	0	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	821	0	2	01	01	H0630_821_0	8		1	05/29/2015	2016.01	05/29/2015 12:56:26 PM Mountain Daylight Time	07/16/2015 11:36:21 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB B Only with D (HMO)	01	01		2	1		H0630	821	0	2016	Northern Colorado		1	0	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0630	822	0	1	01	01	H0630_822_0	9		1	05/29/2015	2016.01	05/29/2015 12:56:32 PM Mountain Daylight Time	07/16/2015 11:36:44 AM Mountain Daylight Time				07/24/2015 01:20:40 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	822	0	2016	Northern Colorado		1	70	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;	1					2	2			
H0657	005	0	1	18	06	H0657_005_0	2		2	06/01/2015	2016.01	06/01/2015 05:24:13 PM Mountain Daylight Time					06/01/2015 05:41:25 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Silver SV Plan (Cost)	06	18		1			H0657	005	0	2016	The 6 County San Luis Valley Area		2	125	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0657	006	0	1	18	06	H0657_006_0	2		2	06/01/2015	2016.01	06/01/2015 05:24:30 PM Mountain Daylight Time					06/01/2015 05:41:25 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Gold SV Plan (Cost)	06	18		1			H0657	006	0	2016	The 6 County San Luis Valley Area		2	50	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0657	007	0	1	18	06	H0657_007_0	2		2	06/01/2015	2016.01	06/01/2015 05:24:48 PM Mountain Daylight Time					06/01/2015 05:41:25 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Platinum SV Plan (Cost)	06	18		1			H0657	007	0	2016	The 6 County San Luis Valley Area		2	520	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0657	008	0	1	18	06	H0657_008_0	2		2	06/01/2015	2016.01	06/01/2015 05:25:07 PM Mountain Daylight Time					06/01/2015 05:41:25 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Silver Plan (Cost)	06	18		1			H0657	008	0	2016	BEN, CHA, CRO, CUS, FRE, HUE, LAS, OTE, PRO, YUM		2	110	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0657	009	0	1	18	06	H0657_009_0	2		2	06/01/2015	2016.01	06/01/2015 05:25:25 PM Mountain Daylight Time					06/01/2015 05:41:25 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Gold Plan (Cost)	06	18		1			H0657	009	0	2016	BEN, CHA, CRO, CUS, FRE, HUE, LAS, OTE, PRO, YUM		2	10	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0657	010	0	1	18	06	H0657_010_0	2		2	06/01/2015	2016.01	06/01/2015 05:25:47 PM Mountain Daylight Time					06/01/2015 05:41:25 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Platinum Plan (Cost)	06	18		1			H0657	010	0	2016	BEN, CHA, CRO, CUS, FRE, HUE, LAS, OTE, PRO, YUM		2	15	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2	2			
H0710	001	0	1	04	01	H0710_001_0	3		1	07/31/2015	2016.01	07/31/2015 09:28:52 AM Central Daylight Time	07/31/2015 01:44:09 PM Central Daylight Time	07/30/2015 07:07:21 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	001	0	2016	State of Connecticut		2		2			1	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	004	0	1	04	01	H0710_004_0	4		1	05/28/2015	2016.01	05/28/2015 02:11:37 PM Central Daylight Time	07/31/2015 01:44:39 PM Central Daylight Time	07/30/2015 07:08:14 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	004	0	2016	Select Counties in Alabama		2		2			1	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	4		1	07/31/2015	2016.01	07/31/2015 03:47:41 PM Central Daylight Time	07/31/2015 01:45:09 PM Central Daylight Time	07/30/2015 07:09:09 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	005	0	2016	Maricopa, Pima, Pinal, and Yavapai counties		2		2			1	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	006	0	1	04	01	H0710_006_0	3		1	05/30/2015	2016.01	05/30/2015 10:03:57 AM Central Daylight Time	07/31/2015 01:45:39 PM Central Daylight Time	07/30/2015 07:09:51 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	006	0	2016	Maricopa, Pima, Pinal, and Yavapai counties		2		2			1	1	2	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	007	0	1	04	01	H0710_007_0	2		1	07/31/2015	2016.01	07/31/2015 03:48:19 PM Central Daylight Time	07/31/2015 01:46:09 PM Central Daylight Time	07/30/2015 07:10:45 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	007	0	2016	Denver Metro area		2		2			1	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	05/29/2015	2016.01	05/29/2015 06:08:22 PM Central Daylight Time	07/31/2015 01:46:39 PM Central Daylight Time	07/30/2015 07:11:27 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	008	0	2016	Denver Metro area		2		2			1	1	2	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	009	0	1	04	01	H0710_009_0	3		1	05/29/2015	2016.01	05/29/2015 06:08:42 PM Central Daylight Time	07/31/2015 01:47:12 PM Central Daylight Time	07/30/2015 07:12:16 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	009	0	2016	State of Connecticut		2		2			1	1	2	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	010	0	1	04	01	H0710_010_0	4		1	07/31/2015	2016.01	07/31/2015 03:49:03 PM Central Daylight Time	07/31/2015 04:22:53 PM Central Daylight Time	07/30/2015 07:13:11 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	010	0	2016	Select Counties in Florida		2		2			1	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	011	0	1	04	01	H0710_011_0	4		1	05/30/2015	2016.01	05/30/2015 10:53:23 AM Central Daylight Time	07/31/2015 01:48:13 PM Central Daylight Time	07/30/2015 07:14:04 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	011	0	2016	Select Counties in Florida		2		2			1	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	012	0	1	04	01	H0710_012_0	3		1	05/29/2015	2016.01	05/29/2015 06:09:35 PM Central Daylight Time	07/31/2015 01:48:43 PM Central Daylight Time	07/30/2015 07:14:47 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	012	0	2016	Select Counties in Florida		2		2			1	1	2	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	013	0	1	04	01	H0710_013_0	4		1	07/31/2015	2016.01	07/31/2015 09:29:45 AM Central Daylight Time	07/31/2015 01:49:14 PM Central Daylight Time	07/30/2015 07:15:40 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	013	0	2016	Select Counties in Indiana		2		2			1	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	014	0	1	04	01	H0710_014_0	4		1	07/31/2015	2016.01	07/31/2015 03:42:29 PM Central Daylight Time	07/31/2015 01:49:44 PM Central Daylight Time	07/30/2015 07:16:38 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	014	0	2016	Johnson, Wyandotte, Cass, and Jackson counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	015	0	1	04	01	H0710_015_0	4		1	05/29/2015	2016.01	05/29/2015 08:42:30 AM Central Daylight Time	07/31/2015 01:50:15 PM Central Daylight Time	07/30/2015 07:17:37 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	015	0	2016	Select Counties in Maine and New Hampshire		2		2			1	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	4		1	05/28/2015	2016.01	05/28/2015 02:15:27 PM Central Daylight Time	07/31/2015 01:50:47 PM Central Daylight Time	07/30/2015 07:18:36 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	016	0	2016	St. Louis Metro area		2		2			1	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	4		1	07/31/2015	2016.01	07/31/2015 03:52:13 PM Central Daylight Time	07/31/2015 01:51:18 PM Central Daylight Time	07/30/2015 07:19:35 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	017	0	2016	Select Counties in Pennsylvania		2		2			1	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	018	0	1	04	01	H0710_018_0	2		1	07/15/2015	2016.01	07/15/2015 04:15:00 PM Central Daylight Time	07/31/2015 01:51:49 PM Central Daylight Time	07/30/2015 07:20:21 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H0710	018	0	2016	Select Counties in Pennsylvania		2		2			1	1	2	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	05/28/2015	2016.01	05/28/2015 02:16:22 PM Central Daylight Time	07/31/2015 01:52:20 PM Central Daylight Time	07/30/2015 07:21:20 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	020	0	2016	Collin, Dallas, Denton, Harris, & Tarrant counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	801	0	1	04	01	H0710_801_0	1		1	04/23/2015	2016.01	04/23/2015 02:22:34 PM Central Daylight Time	05/29/2015 02:49:04 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H0710	801	0	2016	Nationwide		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H0712	005	0	1	01	01	H0712_005_0	3	2	1	05/31/2015	2016.01	05/31/2015 09:04:44 AM Eastern Daylight Time	08/03/2015 01:10:48 PM Eastern Daylight Time	08/03/2015 03:36:26 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H0712	005	0	2016	Fairfield, Hartford Counties		2	5646	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)635-7047		(866)635-7047		(866)527-0056		(866)527-0056		(866)635-7047		(866)635-7047		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H0712	019	0	1	01	01	H0712_019_0	4		1	08/04/2015	2016.01	08/04/2015 07:43:51 AM Eastern Daylight Time	08/03/2015 01:11:38 PM Eastern Daylight Time	08/03/2015 03:36:54 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	Wellcare Value (HMO)	01	01		1			H0712	019	0	2016	Hartford, New Haven, Tolland Counties		2	3367	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)579-8006		(866)579-8006		(866)527-0056		(866)527-0056		(866)579-8006		(866)579-8006		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H0712	020	0	1	01	01	H0712_020_0	4		1	07/10/2015	2016.01	07/10/2015 12:56:11 PM Eastern Daylight Time	08/03/2015 01:12:28 PM Eastern Daylight Time	08/03/2015 03:37:21 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H0712	020	0	2016	Fairfield, Hartford,Tolland Counties		2	937	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)579-8006		(866)579-8006		(866)527-0056		(866)527-0056		(866)579-8006		(866)579-8006		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H0735	001	0	1	04	01	H0735_001_0	8		1	07/14/2015	2016.01	07/14/2015 04:07:32 PM Central Daylight Time	07/30/2015 12:33:37 PM Central Daylight Time	07/30/2015 12:42:38 PM Central Daylight Time			08/04/2015 07:55:29 AM Central Daylight Time	UCARE MINNESOTA	EssentiaCare	www.essentiacare.org	EssentiaCare Secure (PPO)	01	04		1			H0735	001	0	2016	Northern Minnesota		2		2			2							https://www.ucare.org/Pages/FindADoctor.aspx	www.ucare.org	www.ucare.org	(855)432-7025		(218)722-4915		(855)432-7027		(218)722-4783		(855)432-7025		(218)722-4915		(855)432-7027		(218)722-4783		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2						2			
H0735	002	0	1	04	01	H0735_002_0	9		1	07/22/2015	2016.01	07/22/2015 08:04:42 AM Central Daylight Time	07/30/2015 12:35:55 PM Central Daylight Time	07/30/2015 12:36:36 PM Central Daylight Time			08/04/2015 07:55:29 AM Central Daylight Time	UCARE MINNESOTA	EssentiaCare	www.essentiacare.org	EssentiaCare Grand (PPO)	01	04		1			H0735	002	0	2016	Northern Minnesota		2		2			2							https://www.ucare.org/Pages/FindADoctor.aspx	www.ucare.org	www.ucare.org	(855)432-7025		(218)722-4915		(866)457-7144		(612)676-6500		(855)432-7025		(218)722-4915		(855)432-7027		(218)722-4783		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2						2			
H0755	030	0	1	01	01	H0755_030_0	3		1	08/03/2015	2016.01	08/03/2015 01:13:58 PM Central Daylight Time	07/31/2015 12:58:17 PM Central Daylight Time	07/30/2015 07:22:06 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Plan 1 (HMO)	01	01		1			H0755	030	0	2016	Connecticut		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	031	0	1	01	01	H0755_031_0	3		1	07/31/2015	2016.01	07/31/2015 09:51:40 AM Central Daylight Time	07/31/2015 12:58:41 PM Central Daylight Time	07/30/2015 07:22:49 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Plan 2 (HMO)	01	01		1			H0755	031	0	2016	Connecticut		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	032	0	1	01	01	H0755_032_0	2		1	07/13/2015	2016.01	07/13/2015 08:23:30 AM Central Daylight Time	05/29/2015 02:45:13 PM Central Daylight Time				07/13/2015 01:27:27 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Essential (HMO)	01	01		1			H0755	032	0	2016	Connecticut		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0755	033	0	1	01	01	H0755_033_0	3		1	07/31/2015	2016.01	07/31/2015 09:52:07 AM Central Daylight Time	07/31/2015 12:59:05 PM Central Daylight Time	07/30/2015 07:23:34 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Plan 3 (HMO)	01	01		1			H0755	033	0	2016	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	810	0	1	01	01	H0755_810_0	1		1	04/13/2015	2016.01	04/13/2015 11:03:51 AM Central Daylight Time	05/29/2015 02:46:01 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	810	0	2016	Connecticut		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H0755	811	0	1	01	01	H0755_811_0	1		1	04/13/2015	2016.01	04/13/2015 11:05:41 AM Central Daylight Time	05/29/2015 02:46:26 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	811	0	2016	Connecticut		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H0755	812	0	1	01	01	H0755_812_0	1		1	04/13/2015	2016.01	04/13/2015 11:06:13 AM Central Daylight Time	05/29/2015 02:46:50 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	812	0	2016	Connecticut		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H0809	001	0	1	20	08	H0809_001_0	1		1	05/29/2015	2016.01	05/29/2015 11:06:45 AM Eastern Daylight Time		05/27/2015 09:13:09 AM Eastern Daylight Time			05/29/2015 11:09:59 AM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mymercylife.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	001	0	2016	Mercy LIFE		2		2			2								www.mercycares.com	www.mercycares.com									(800)000-0000		(413)827-4318		(800)000-0000		(413)827-4318										(800)000-0000		(413)827-4318		(800)000-0000		(413)827-4318																
H0809	002	0	1	20	08	H0809_002_0	1		1	05/29/2015	2016.01	05/29/2015 11:07:16 AM Eastern Daylight Time		05/27/2015 09:14:39 AM Eastern Daylight Time			05/29/2015 11:09:59 AM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mymercylife.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	002	0	2016	Mercy LIFE		2		2			2								www.mercycares.com	www.mercycares.com									(800)000-0000		(413)827-4318		(800)000-0000		(413)827-4318										(800)000-0000		(413)827-4318		(800)000-0000		(413)827-4318																
H0811	001	0	1	49	05	H0811_001_0	5		1	08/26/2015	2016.01	08/26/2015 09:35:17 AM Eastern Daylight Time					08/26/2015 10:54:48 AM Eastern Daylight Time	GUILDNET, INC.	GuildNet Gold Plus FIDA	http://www.guildnetny.org	GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)	05	49		1			H0811	001	0	2016	Counties: Ki, Qu  Brx, NY, Ri, Wes, Suf, Na		2		2			2							http://www.guildnetny.org	http://www.guildnetny.org	http://www.guildnetny.org	(800)815-0000		(800)815-0000		(800)815-0000		(800)815-0000		(877)444-3973		(877)444-3973		(800)815-0000		(800)815-0000		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)248-0640		(866)248-0640		(800)662-1220		(800)662-1220		2					2					2				
H0819	001	0	1	20	08	H0819_001_0	1		1	05/20/2015	2016.01	05/20/2015 10:22:44 AM Eastern Daylight Time		05/18/2015 02:43:55 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIOR LIFE YORK, INC.	York County PACE	http://www.seniorlifeyork.com	Senior LIFE York Dual Eligible (PACE)	08	20		1			H0819	001	0	2016	York County PACE		2	117	2			2								www.seniorlifeyork.com	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H0819	002	0	1	20	08	H0819_002_0	1		1	05/20/2015	2016.01	05/20/2015 10:23:34 AM Eastern Daylight Time		05/18/2015 02:43:55 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIOR LIFE YORK, INC.	York County PACE	http://www.seniorlifeyork.com	Senior LIFE York Medicare Only (PACE)	08	20		1			H0819	002	0	2016	York County PACE Medicare Only		2	1	2			2								www.seniorlifeyork.com	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H0838	020	0	1	01	01	H0838_020_0	15		1	08/03/2015	2016.01	08/03/2015 02:30:13 PM Pacific Daylight Time	07/30/2015 11:18:54 AM Pacific Daylight Time	07/30/2015 01:52:48 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Harmony - Dual Access (HMO SNP)	01	01		1			H0838	020	0	2016	Counties: KERN, KINGS, LA, ORA, RIV, SAN BERN		2	3910	2			1	4		1		00000000000010000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	024	0	1	01	01	H0838_024_0	15	2	1	07/30/2015	2016.01	07/30/2015 10:50:47 AM Pacific Daylight Time	07/30/2015 11:26:39 AM Pacific Daylight Time	07/30/2015 02:00:46 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Dual Coverage (HMO SNP)	01	01		1			H0838	024	0	2016	Counties: KERN, KINGS, LA, ORA, RIV, SAN BERN		2	2774	2			1	3		1	4			www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	025	0	1	01	01	H0838_025_0	15		1	07/30/2015	2016.01	07/30/2015 10:48:25 AM Pacific Daylight Time	07/30/2015 11:23:29 AM Pacific Daylight Time	07/30/2015 02:01:25 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Classic Care (HMO)	01	01		1			H0838	025	0	2016	Counties:  KERN, KING, LA, ORA, RIV, SAN BERN		2	1450	2			2							www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	026	0	1	01	01	H0838_026_0	15		1	07/30/2015	2016.01	07/30/2015 10:48:35 AM Pacific Daylight Time	07/30/2015 11:23:55 AM Pacific Daylight Time	07/30/2015 02:01:59 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	In Control Drug Savings (HMO SNP)	01	01		1			H0838	026	0	2016	Counties:  KERN, KINGS, LA, ORA, RIV, SAN BERN		2	779	2			1	4		1		00000010000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	027	0	1	01	01	H0838_027_0	15		1	08/03/2015	2016.01	08/03/2015 02:32:42 PM Pacific Daylight Time	07/30/2015 11:24:15 AM Pacific Daylight Time	07/30/2015 02:02:37 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	In Control - Dual Access (HMO SNP)	01	01		1			H0838	027	0	2016	Counties:  KERN, KINGS, LA, ORA, RIV, SAN BERN		2	2492	2			1	4		1		00000010000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	028	0	1	01	01	H0838_028_0	15		1	08/03/2015	2016.01	08/03/2015 02:57:56 PM Pacific Daylight Time	08/04/2015 08:14:46 AM Pacific Daylight Time	07/30/2015 02:03:09 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Bridges Drug Savings (HMO SNP)	01	01		1			H0838	028	0	2016	Counties:  KERN, LA, ORA, RIV, SAN BERN		2	318	2			1	4		1		00000100000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	029	0	1	01	01	H0838_029_0	15		1	07/30/2015	2016.01	07/30/2015 10:51:34 AM Pacific Daylight Time	07/30/2015 11:24:56 AM Pacific Daylight Time	07/30/2015 02:03:50 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Bridges - Dual Access (HMO SNP)	01	01		1			H0838	029	0	2016	Counties:  KERN, LA, ORA, RIV, SAN BERN		2	743	2			1	4		1		00000100000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	030	0	1	01	01	H0838_030_0	15		1	07/30/2015	2016.01	07/30/2015 10:49:23 AM Pacific Daylight Time	07/30/2015 11:25:16 AM Pacific Daylight Time	07/30/2015 02:04:32 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Healthy Heart Drug Savings (HMO SNP)	01	01		1			H0838	030	0	2016	Counties: KERN, KINGS, LA, ORA, RIV, SAN BERN		2	583	2			1	4		1		00001000000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	031	0	1	01	01	H0838_031_0	15		1	07/30/2015	2016.01	07/30/2015 10:52:05 AM Pacific Daylight Time	07/30/2015 11:25:36 AM Pacific Daylight Time	07/30/2015 02:04:59 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Healthy Heart - Dual Access (HMO SNP)	01	01		1			H0838	031	0	2016	Counties:  KERN, KINGS, LA, ORA, RIV, SAN BERN		2	1322	2			1	4		1		00001000000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	032	0	1	01	01	H0838_032_0	14		1	07/30/2015	2016.01	07/30/2015 10:47:44 AM Pacific Daylight Time	07/30/2015 11:25:54 AM Pacific Daylight Time	07/30/2015 02:05:31 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Hope Drug Savings (HMO SNP)	01	01		1			H0838	032	0	2016	Counties: KERN, KINGS, LA, ORA, RIV, SAN BERN		2	197	2			1	4		1		00000000000010000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0838	033	0	1	01	01	H0838_033_0	15		1	07/30/2015	2016.01	07/30/2015 10:52:32 AM Pacific Daylight Time	07/30/2015 11:26:16 AM Pacific Daylight Time	07/30/2015 02:06:29 PM Pacific Daylight Time			08/10/2015 01:35:48 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Classic Choice for Medi-Medi (HMO)	01	01		1			H0838	033	0	2016	KERN, KINGS, LA, ORA, RIV, SAN BERN		2	1024	2			2							www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2	2			
H0839	001	0	1	20	08	H0839_001_0	1		1	05/29/2015	2016.01	05/29/2015 12:33:07 PM Eastern Daylight Time		05/19/2015 10:42:18 AM Eastern Daylight Time			05/29/2015 12:35:30 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	Senior CommUnity Care of North Carolina	www.seniorcommunitycarenc.org	Senior Community Care of North Carolina (PACE)	08	20		1			H0839	001	0	2016	Senior Community Care of North Carolina		2		2			2								www.seniorcommunitycarenc.org	www.seniorcommunitycarenc.org									(800)000-0000		(919)425-3000		(800)000-0000		(919)425-3000										(800)000-0000		(919)425-3000		(800)000-0000		(919)425-3000																
H0839	002	0	1	20	08	H0839_002_0	1		1	05/29/2015	2016.01	05/29/2015 12:33:36 PM Eastern Daylight Time		05/19/2015 10:44:18 AM Eastern Daylight Time			05/29/2015 12:35:30 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	Senior CommUnity Care of North Carolina	www.seniorcommunitycarenc.org	Senior Community Care of North Carolina (PACE)	08	20		1			H0839	002	0	2016	Senior Community Care of North Carolina		2		2			2								www.seniorcommunitycarenc.org	www.seniorcommunitycarenc.org									(800)000-0000		(919)425-3000		(800)000-0000		(919)425-3000										(800)000-0000		(919)425-3000		(800)000-0000		(919)425-3000																
H0840	001	0	1	04	01	H0840_001_0	12		1	09/23/2015	2016.01	09/23/2015 12:11:04 PM Pacific Daylight Time	08/03/2015 10:58:24 AM Pacific Daylight Time	07/29/2015 01:58:54 PM Pacific Daylight Time			09/23/2015 12:46:56 PM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycareinc.org	FamilyCare Choice Rx (PPO)	01	04		1			H0840	001	0	2016	Multnomah, Clackamas, Washington, Morrow, Umatilla		2	39	2			2							www.familycarehealthplans.org	www.familycareinc.org	http://www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(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			
H0840	002	0	1	04	01	H0840_002_0	12		1	09/23/2015	2016.01	09/23/2015 12:13:26 PM Pacific Daylight Time	06/19/2015 03:28:06 PM Pacific Daylight Time				09/23/2015 12:46:56 PM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycareinc.org	FamilyCare Choice (PPO)	01	04		1			H0840	002	0	2016	Multnomah, Clackamas, Washington, Morrow, Umatilla		2	77	2			2							www.familycarehealthplans.org	www.familycareinc.org	http://www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H0879	002	0	1	04	01	H0879_002_0	11		1	08/04/2015	2016.01	08/04/2015 02:04:57 PM Eastern Daylight Time	08/04/2015 01:46:39 PM Eastern Daylight Time	08/04/2015 01:46:40 PM Eastern Daylight Time			08/04/2015 02:06:58 PM Eastern Daylight Time	CRESTPOINT HEALTH INSURANCE COMPANY	CrestPoint Health Insurance Company	www.yourcrestpointhealth.com	CrestPoint Health Classic (PPO)	01	04		1			H0879	002	0	2016	Northeast Tennessee		2	7125	2			2							www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		2					2						2			
H0879	004	0	1	04	01	H0879_004_0	8		1	07/15/2015	2016.01	07/15/2015 10:05:32 AM Eastern Daylight Time	06/01/2015 02:47:56 PM Eastern Daylight Time				07/15/2015 10:12:36 AM Eastern Daylight Time	CRESTPOINT HEALTH INSURANCE COMPANY	CrestPoint Health Insurance Company	www.yourcrestpointhealth.com	CrestPoint Health Value (PPO)	01	04		1			H0879	004	0	2016	Northeast Tennessee		2	375	2			2							www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228										(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298										2					2						2			
H0908	001	0	1	01	01	H0908_001_0	5	2	1	08/04/2015	2016.01	08/04/2015 03:18:03 PM Pacific Daylight Time	08/03/2015 09:53:03 AM Pacific Daylight Time	07/30/2015 12:03:20 PM Pacific Daylight Time			08/04/2015 03:25:50 PM Pacific Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Buckeye Health Plan	http://advantage.bchpohio.com	Buckeye Health Plan Advantage (HMO SNP)	01	01		1			H0908	001	0	2016	Northwest, Northeast, Southwest, and Eastern Ohio		2	697	2			1	3		1	2			http://advantage.buckeyehealthplan.com/home/find-a-provider-or-pharmacy/	http://advantage.buckeyehealthplan.com/home/prescription-drug-part-d-benefit-information/formulary/	http://advantage.buckeyehealthplan.com/home/find-a-provider-or-pharmacy/	(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0913	002	0	1	01	01	H0913_002_0	4		1	08/01/2015	2016.01	08/01/2015 09:22:31 AM Eastern Daylight Time	08/03/2015 01:13:19 PM Eastern Daylight Time	08/03/2015 03:37:50 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H0913	002	0	2016	Essex, Hudson Counties		2	844	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8570		(866)687-8570		(866)527-0056		(866)527-0056		(866)687-8570		(866)687-8570		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H0913	012	0	1	01	01	H0913_012_0	4		1	08/01/2015	2016.01	08/01/2015 09:22:47 AM Eastern Daylight Time	08/03/2015 01:14:09 PM Eastern Daylight Time	08/03/2015 03:38:17 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H0913	012	0	2016	Middlesex, Passaic Counties		2	698	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8570		(866)687-8570		(866)527-0056		(866)527-0056		(866)687-8570		(866)687-8570		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H0913	013	0	1	01	01	H0913_013_0	4	2	1	05/31/2015	2016.01	05/31/2015 09:08:41 AM Eastern Daylight Time	08/03/2015 01:14:59 PM Eastern Daylight Time	08/03/2015 03:38:46 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H0913	013	0	2016	Select Counties in NJ		2		2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9496		(866)530-9496		(866)527-0056		(866)527-0056		(866)687-8570		(866)687-8570		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H0927	001	0	1	48	05	H0927_001_0	3		1	08/24/2015	2016.01	08/24/2015 02:22:48 PM Central Daylight Time					08/24/2015 02:31:29 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Community MMAI	www.hcsc.com	Blue Medicare Advantage (Medicare-Medicaid Plan)	05	48		1			H0927	001	0	2016	Cook, DuPage, Kane, Kankakee, Lake, and Will ctys		2	12000	2			2								https://myprime.com	www.yourpartd.com	(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H0981	001	0	1	01	01	H0981_001_0	5		1	08/04/2015	2016.01	08/04/2015 02:09:41 PM Eastern Daylight Time	07/30/2015 03:51:55 PM Eastern Daylight Time	07/30/2015 03:58:19 PM Eastern Daylight Time			08/05/2015 03:19:48 PM Eastern Daylight Time	EDEN HEALTH PLANS, INC.	Eden Health Plans, Inc.	www.edenhealthplans.com	Eden Gold (HMO)	01	01		1			H0981	001	0	2016	MD		2		2			2							www.edenhealthplans.com	www.edenhealthplans.com	edenhealthplans.com			(786)391-1391				(786)391-1391		(000)000-0000		(786)391-1391		(000)000-0000		(786)391-1391		(000)-		(000)-		(000)-		(000)-		(000)-		(000)-		(000)-		(000)-		2					1					2	2			
H0981	002	0	1	01	01	H0981_002_0	6		1	06/26/2015	2016.01	06/26/2015 10:09:08 AM Eastern Daylight Time	07/30/2015 03:53:36 PM Eastern Daylight Time	07/30/2015 03:59:07 PM Eastern Daylight Time			08/05/2015 03:19:48 PM Eastern Daylight Time	EDEN HEALTH PLANS, INC.	Eden Health Plans, Inc.	www.edenhealthplans.com	Eden Gold (HMO)	01	01		1			H0981	002	0	2016	BR PB BV VO PO PN HB		2		2			2							www.edenhealthplans.com	edenhealthplans.com	edenhealthplans.com	(000)000-0000		(786)391-1391		(000)000-0000		(786)391-1391		(000)000-0000		(786)391-1391		(000)000-0000		(786)391-1391		(000)-		(000)-		(000)-		(000)-		(000)-		(000)-		(000)-		(000)-		2					2					2	2			
H1016	001	0	1	01	01	H1016_001_0	12		1	07/16/2015	2016.01	07/16/2015 05:33:33 PM Eastern Daylight Time	08/04/2015 08:57:26 AM Eastern Daylight Time	08/04/2015 08:57:26 AM Eastern Daylight Time			08/04/2015 09:06:53 AM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	001	0	2016	Miami-Dade County		2	13500	2			2							www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;	
H1016	021	0	1	01	01	H1016_021_0	7		1	07/16/2015	2016.01	07/16/2015 05:33:05 PM Eastern Daylight Time	08/04/2015 08:57:40 AM Eastern Daylight Time	08/04/2015 08:57:40 AM Eastern Daylight Time			08/04/2015 09:06:53 AM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	021	0	2016	Broward County		2	16000	2			2							www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;	
H1016	801	0	1	01	01	H1016_801_0	5		1	05/30/2015	2016.01	05/30/2015 09:59:13 PM Eastern Daylight Time	07/17/2015 03:31:18 PM Eastern Daylight Time				07/17/2015 06:01:33 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Plan (HMO)	01	01		1			H1016	801	0	2016	AvMed Florida Employer Group Plan		1		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)-		1	2		2		1					1	2			
H1016	802	0	1	01	01	H1016_802_0	4		1	05/30/2015	2016.01	05/30/2015 09:59:22 PM Eastern Daylight Time	07/17/2015 03:34:26 PM Eastern Daylight Time				07/17/2015 06:01:33 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Plan (HMO)	01	01		1			H1016	802	0	2016	AvMed Florida Employer Group Plan		1		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)-										1	2		2		1					1	2			
H1016	803	0	1	01	01	H1016_803_0	4		1	05/30/2015	2016.01	05/30/2015 09:59:30 PM Eastern Daylight Time	07/17/2015 03:32:46 PM Eastern Daylight Time				07/17/2015 06:01:33 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	2016	AvMed Florida  Employer Group Plan		1		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)-		1	2		2		1					1	2			
H1016	804	0	1	01	01	H1016_804_0	4		1	05/30/2015	2016.01	05/30/2015 09:59:38 PM Eastern Daylight Time	07/17/2015 03:35:44 PM Eastern Daylight Time				07/17/2015 06:01:33 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	2016	AvMed Florida Employer Group Plan		1		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)-										1	2		2		1					1	2			
H1019	001	0	1	01	01	H1019_001_0	2		1	05/27/2015	2016.01	05/27/2015 11:08:21 AM Eastern Daylight Time	08/01/2015 09:29:36 AM Eastern Daylight Time	07/29/2015 08:45:26 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	001	0	2016	Broward County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	07/08/2015	2016.01	07/08/2015 12:34:34 PM Eastern Daylight Time	08/01/2015 11:44:13 AM Eastern Daylight Time	07/29/2015 08:46:00 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	006	0	2016	Miami-Dade County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	023	0	1	01	01	H1019_023_0	5	2	1	07/20/2015	2016.01	07/20/2015 04:42:55 PM Eastern Daylight Time	08/01/2015 10:05:03 AM Eastern Daylight Time	07/29/2015 08:46:36 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	023	0	2016	Broward and Palm Beach counties		2		2			1	3		1	3		2	www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	024	0	1	01	01	H1019_024_0	6	2	1	07/21/2015	2016.01	07/21/2015 10:56:42 AM Eastern Daylight Time	08/01/2015 10:07:41 AM Eastern Daylight Time	07/29/2015 08:47:12 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	024	0	2016	Miami-Dade County		2		2			1	3		1	3		2	www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	5	2	1	07/20/2015	2016.01	07/20/2015 04:56:16 PM Eastern Daylight Time	08/01/2015 10:10:46 AM Eastern Daylight Time	07/29/2015 08:47:48 PM Eastern Daylight Time			08/04/2015 01:07:16 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	026	0	2016	Hillsborough, Pasco, Pinellas and Polk counties		2		2			1	3		1	3		2	www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	027	0	1	01	01	H1019_027_0	2		1	07/06/2015	2016.01	07/06/2015 11:51:43 AM Eastern Daylight Time	08/01/2015 09:32:47 AM Eastern Daylight Time	07/29/2015 08:48:24 PM Eastern Daylight Time			08/04/2015 01:52:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	027	0	2016	Lake, Marion and Sumter Counties		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	028	0	1	01	01	H1019_028_0	5	2	1	07/20/2015	2016.01	07/20/2015 04:52:50 PM Eastern Daylight Time	08/01/2015 10:13:37 AM Eastern Daylight Time	07/29/2015 08:49:00 PM Eastern Daylight Time			08/04/2015 01:52:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	028	0	2016	Select Counties in Florida		2		2			1	3		1	3		2	www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	2		1	05/27/2015	2016.01	05/27/2015 11:09:54 AM Eastern Daylight Time	08/01/2015 12:46:27 PM Eastern Daylight Time	07/29/2015 08:49:34 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	043	0	2016	Treasure Coast Area		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	054	0	1	01	01	H1019_054_0	2		1	05/27/2015	2016.01	05/27/2015 11:44:20 AM Eastern Daylight Time	08/01/2015 09:38:08 AM Eastern Daylight Time	07/29/2015 08:50:10 PM Eastern Daylight Time			08/04/2015 01:07:16 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	054	0	2016	Hillsborough, Pasco, Pinellas and Polk counties		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	057	0	1	01	01	H1019_057_0	2		1	05/28/2015	2016.01	05/28/2015 09:16:18 AM Eastern Daylight Time	08/03/2015 09:23:41 AM Eastern Daylight Time	07/29/2015 08:50:46 PM Eastern Daylight Time			08/04/2015 01:52:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	057	0	2016	Orange, Osceola and Seminole counties		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	060	0	1	01	01	H1019_060_0	2		1	05/27/2015	2016.01	05/27/2015 11:44:27 AM Eastern Daylight Time	08/01/2015 09:49:43 AM Eastern Daylight Time	07/29/2015 08:51:22 PM Eastern Daylight Time			08/04/2015 01:07:16 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	060	0	2016	Hillsborough, Pasco, Pinellas and Polk counties		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	062	0	1	01	01	H1019_062_0	2		1	05/27/2015	2016.01	05/27/2015 11:10:00 AM Eastern Daylight Time	08/01/2015 09:53:44 AM Eastern Daylight Time	07/29/2015 08:51:58 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareHeart (HMO SNP)	01	01		1			H1019	062	0	2016	Broward County		2		2			1	4		1		00000000000000010000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	063	0	1	01	01	H1019_063_0	3		1	07/08/2015	2016.01	07/08/2015 12:37:43 PM Eastern Daylight Time	08/01/2015 09:55:09 AM Eastern Daylight Time	07/29/2015 08:52:32 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareHeart (HMO SNP)	01	01		1			H1019	063	0	2016	Miami-Dade County		2		2			1	4		1		00000000000000010000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	2		1	05/27/2015	2016.01	05/27/2015 11:10:14 AM Eastern Daylight Time	08/01/2015 09:57:40 AM Eastern Daylight Time	07/29/2015 08:53:08 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	065	0	2016	Palm Beach County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	07/08/2015	2016.01	07/08/2015 04:46:34 PM Eastern Daylight Time	08/01/2015 09:59:13 AM Eastern Daylight Time	07/29/2015 08:53:44 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	069	0	2016	Duval County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	5	2	1	07/20/2015	2016.01	07/20/2015 04:43:54 PM Eastern Daylight Time	08/01/2015 10:17:30 AM Eastern Daylight Time	07/29/2015 08:54:18 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds PLUS (HMO SNP)	01	01		1			H1019	073	0	2016	Duval County		2		2			1	3		1	3		2	www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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	2		1	05/27/2015	2016.01	05/27/2015 11:10:49 AM Eastern Daylight Time	08/01/2015 10:00:45 AM Eastern Daylight Time	07/29/2015 08:54:54 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree PLUS (HMO)	01	01		1			H1019	076	0	2016	Miami-Dade County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	077	0	1	01	01	H1019_077_0	5	2	1	07/20/2015	2016.01	07/20/2015 04:53:12 PM Eastern Daylight Time	08/01/2015 10:15:37 AM Eastern Daylight Time	07/29/2015 08:55:28 PM Eastern Daylight Time			08/04/2015 01:52:09 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	077	0	2016	Select Counties in Florida		2		2			1	3		1	4			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	079	0	1	01	01	H1019_079_0	5	2	1	07/20/2015	2016.01	07/20/2015 04:56:38 PM Eastern Daylight Time	08/01/2015 10:12:03 AM Eastern Daylight Time	07/29/2015 08:56:04 PM Eastern Daylight Time			08/04/2015 01:07:16 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	079	0	2016	Hillsborough, Pasco, Pinellas and Polk counties		2		2			1	3		1	4			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	081	0	1	01	01	H1019_081_0	5	2	1	07/20/2015	2016.01	07/20/2015 04:44:18 PM Eastern Daylight Time	08/01/2015 10:06:24 AM Eastern Daylight Time	07/29/2015 08:56:40 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	081	0	2016	Broward and Palm Beach counties		2		2			1	3		1	4			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	083	0	1	01	01	H1019_083_0	6	2	1	07/22/2015	2016.01	07/22/2015 10:26:29 AM Eastern Daylight Time	08/01/2015 10:09:01 AM Eastern Daylight Time	07/29/2015 08:57:14 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	083	0	2016	Miami-Dade County		2		2			1	3		1	4			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1019	085	0	1	01	01	H1019_085_0	5	2	1	07/20/2015	2016.01	07/20/2015 04:45:09 PM Eastern Daylight Time	08/01/2015 10:20:37 AM Eastern Daylight Time	07/29/2015 08:57:50 PM Eastern Daylight Time			08/04/2015 01:19:31 PM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	085	0	2016	Duval County		2		2			1	3		1	4			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	http://www.care-plus-health-plans.com/medicare-plans/2015-prescription-drug-guides.asp	http://www.care-plus-health-plans.com/provider-pharmacy-directories.asp	(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			
H1026	001	0	1	01	01	H1026_001_0	3		1	08/03/2015	2016.01	08/03/2015 10:40:18 AM Eastern Daylight Time	08/03/2015 12:08:28 PM Eastern Daylight Time	07/29/2015 04:12:33 PM Eastern Daylight Time			08/04/2015 04:27:35 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO LifeTime (HMO)	01	01		1			H1026	001	0	2016	Miami-Dade County		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1026	038	0	1	01	01	H1026_038_0	4		1	07/31/2015	2016.01	07/31/2015 02:08:11 PM Eastern Daylight Time	08/05/2015 01:34:48 PM Eastern Daylight Time	07/29/2015 04:14:58 PM Eastern Daylight Time			08/05/2015 04:18:33 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO LifeTime (HMO)	01	01		1			H1026	038	0	2016	Palm Beach and Pinellas Counties		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1026	040	0	1	01	01	H1026_040_0	3		1	07/31/2015	2016.01	07/31/2015 02:11:30 PM Eastern Daylight Time	08/03/2015 12:32:41 PM Eastern Daylight Time	07/29/2015 04:16:11 PM Eastern Daylight Time			08/04/2015 04:27:35 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO LifeTime (HMO)	01	01		1			H1026	040	0	2016	South, Central and NE counties		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1026	055	0	1	01	01	H1026_055_0	3		1	07/31/2015	2016.01	07/31/2015 02:12:24 PM Eastern Daylight Time	08/03/2015 12:33:18 PM Eastern Daylight Time	07/29/2015 04:17:56 PM Eastern Daylight Time			08/04/2015 04:27:35 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO MyTime (HMO)	01	01		1			H1026	055	0	2016	Broward County		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1026	056	0	1	01	01	H1026_056_0	3		1	07/31/2015	2016.01	07/31/2015 02:13:08 PM Eastern Daylight Time	08/03/2015 12:33:58 PM Eastern Daylight Time	07/29/2015 04:18:59 PM Eastern Daylight Time			08/04/2015 04:27:35 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO MyTime (HMO)	01	01		1			H1026	056	0	2016	Orange, Osceola and Seminole counties		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1026	057	0	1	01	01	H1026_057_0	3		1	06/01/2015	2016.01	06/01/2015 03:05:05 PM Eastern Daylight Time	08/03/2015 12:34:44 PM Eastern Daylight Time	07/29/2015 04:26:23 PM Eastern Daylight Time			08/04/2015 04:27:35 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO MyTime (HMO)	01	01		1			H1026	057	0	2016	Hillsborough, Hernando, Pasco and Polk counties		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1026	058	0	1	01	01	H1026_058_0	5		1	08/03/2015	2016.01	08/03/2015 09:43:20 AM Eastern Daylight Time	08/03/2015 12:35:14 PM Eastern Daylight Time	07/29/2015 04:27:41 PM Eastern Daylight Time			08/04/2015 04:27:35 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO MyTime (HMO)	01	01		1			H1026	058	0	2016	Palm Beach County		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2	2			
H1032	032	0	1	01	01	H1032_032_0	4		1	08/05/2015	2016.01	08/05/2015 09:21:40 AM Eastern Daylight Time	08/05/2015 09:41:58 AM Eastern Daylight Time	08/03/2015 03:39:14 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	032	0	2016	Select Counties in FL		2	6438	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	040	0	1	01	01	H1032_040_0	4		1	08/01/2015	2016.01	08/01/2015 09:35:08 AM Eastern Daylight Time	08/03/2015 01:16:44 PM Eastern Daylight Time	08/03/2015 03:39:42 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	040	0	2016	Miami-Dade County		2	917	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	061	0	1	01	01	H1032_061_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:20:45 PM Eastern Daylight Time	08/03/2015 01:17:34 PM Eastern Daylight Time	08/03/2015 03:40:10 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Select (HMO SNP)	01	01		1			H1032	061	0	2016	Select Counties in FL		2	4867	2			1	3		1	4			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	073	0	1	01	01	H1032_073_0	5		1	08/01/2015	2016.01	08/01/2015 09:35:23 AM Eastern Daylight Time	08/03/2015 01:18:31 PM Eastern Daylight Time	08/03/2015 03:40:39 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H1032	073	0	2016	Duval Counties		2	3613	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	079	0	1	02	01	H1032_079_0	4		1	08/01/2015	2016.01	08/01/2015 09:35:36 AM Eastern Daylight Time	08/03/2015 01:19:24 PM Eastern Daylight Time	08/03/2015 03:41:06 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H1032	079	0	2016	Select Counties in FL		2	1606	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	091	0	1	02	01	H1032_091_0	4		1	08/01/2015	2016.01	08/01/2015 09:35:49 AM Eastern Daylight Time	08/03/2015 01:20:15 PM Eastern Daylight Time	08/03/2015 03:41:34 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	01	02		1			H1032	091	0	2016	Select Counties in FL		2	21225	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	124	0	1	01	01	H1032_124_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:21:49 PM Eastern Daylight Time	08/03/2015 01:21:05 PM Eastern Daylight Time	08/03/2015 03:42:02 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1032	124	0	2016	Select Counties in FL		2	13823	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	133	0	1	02	01	H1032_133_0	5		1	08/01/2015	2016.01	08/01/2015 09:36:02 AM Eastern Daylight Time	08/03/2015 01:21:58 PM Eastern Daylight Time	08/03/2015 03:42:31 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H1032	133	0	2016	Select Counties in FL		2	1451	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	170	0	1	01	01	H1032_170_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:22:02 PM Eastern Daylight Time	08/03/2015 01:22:50 PM Eastern Daylight Time	08/03/2015 03:42:58 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1032	170	0	2016	Miami-Dade County		2	200	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	174	0	1	02	01	H1032_174_0	4		1	08/01/2015	2016.01	08/01/2015 09:36:14 AM Eastern Daylight Time	08/03/2015 01:23:40 PM Eastern Daylight Time	08/03/2015 03:43:27 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	01	02		1			H1032	174	0	2016	Select Counties in FL		2	10273	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	175	0	1	01	01	H1032_175_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:22:19 PM Eastern Daylight Time	08/03/2015 01:24:32 PM Eastern Daylight Time	08/03/2015 03:43:54 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H1032	175	0	2016	Select Counties in FL		2	13223	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	176	0	1	01	01	H1032_176_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:22:29 PM Eastern Daylight Time	08/03/2015 01:25:25 PM Eastern Daylight Time	08/03/2015 03:44:24 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H1032	176	0	2016	Miami-Dade County		2	345	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	179	0	1	01	01	H1032_179_0	5		1	08/01/2015	2016.01	08/01/2015 09:36:29 AM Eastern Daylight Time	08/03/2015 01:26:15 PM Eastern Daylight Time	08/03/2015 03:44:51 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	179	0	2016	Select Counties in FL		2	14012	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	180	0	1	01	01	H1032_180_0	6		1	08/01/2015	2016.01	08/01/2015 09:36:41 AM Eastern Daylight Time	08/03/2015 01:27:07 PM Eastern Daylight Time	08/03/2015 03:45:18 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1032	180	0	2016	Select Counties in FL		2	2486	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	182	0	1	01	01	H1032_182_0	6	2	1	07/10/2015	2016.01	07/10/2015 01:22:52 PM Eastern Daylight Time	08/03/2015 01:27:58 PM Eastern Daylight Time	08/03/2015 03:45:45 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Select (HMO SNP)	01	01		1			H1032	182	0	2016	Select Counties in FL		2	244	2			1	3		1	4			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)637-8041		(866)637-8041		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1032	183	0	1	01	01	H1032_183_0	7		1	07/10/2015	2016.01	07/10/2015 01:23:03 PM Eastern Daylight Time	08/03/2015 01:28:48 PM Eastern Daylight Time	08/03/2015 03:46:14 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO)	01	01		1			H1032	183	0	2016	Select Counties in FL		2	12	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)888-9355		(888)888-9355		(866)527-0056		(866)527-0056		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1035	002	0	1	02	01	H1035_002_0	4		1	08/05/2015	2016.01	08/05/2015 03:58:15 PM Eastern Daylight Time	08/05/2015 02:54:20 PM Eastern Daylight Time	08/05/2015 02:53:27 PM Eastern Daylight Time			08/05/2015 04:01:57 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP's Medvantage Rx Plus (HMO-POS)	01	02		1			H1035	002	0	2016	Flagler, Seminole and Volusia Counties, FL		2	10760	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(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			
H1035	006	0	1	01	01	H1035_006_0	5		1	08/05/2015	2016.01	08/05/2015 03:55:49 PM Eastern Daylight Time	08/05/2015 01:58:27 PM Eastern Daylight Time	08/05/2015 02:50:35 PM Eastern Daylight Time			08/05/2015 04:01:57 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP's  Medvantage Rx (HMO)	01	01		1			H1035	006	0	2016	Flagler, Seminole and Volusia Counties, FL		2	2700	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(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			
H1035	007	0	1	02	01	H1035_007_0	4		1	07/10/2015	2016.01	07/10/2015 10:28:47 AM Eastern Daylight Time	07/10/2015 04:48:19 PM Eastern Daylight Time				07/16/2015 04:33:49 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP's Medvantage (HMO-POS)	01	02		1			H1035	007	0	2016	Flagler, Seminole and Volusia Counties, FL		2	220	2			2							www.fhcp.com/medicare-MAdirectory	www.fhcp.com/medicare/medicare-formulary	www.fhcp.com/medicare-MAdirectory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771										2					2					2	2			
H1035	010	0	1	01	01	H1035_010_0	4		1	07/10/2015	2016.01	07/10/2015 10:28:14 AM Eastern Daylight Time	08/05/2015 01:58:24 PM Eastern Daylight Time	08/05/2015 02:50:35 PM Eastern Daylight Time			08/05/2015 04:01:57 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP's Premier Plan (HMO)	01	01		1			H1035	010	0	2016	Brevard County		2	500	2			2							www.fhcp.com/medicare-directory-brevard	www.fhcp.com/medicare-formulary-brevard	www.fhcp.com/medicare-directory-brevard	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(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			
H1035	011	0	1	02	01	H1035_011_0	4		1	07/10/2015	2016.01	07/10/2015 10:28:54 AM Eastern Daylight Time	08/05/2015 01:58:26 PM Eastern Daylight Time	08/05/2015 02:50:34 PM Eastern Daylight Time			08/05/2015 04:01:57 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP's Premier Plus Plan (HMO-POS)	01	02		1			H1035	011	0	2016	Brevard County		2	500	2			2							www.fhcp.com/medicare-directory-brevard	www.fhcp.com/medicare-formulary-brevard	www.fhcp.com/medicare-directory-brevard	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(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			
H1035	012	0	1	01	01	H1035_012_0	6		1	09/10/2015	2016.01	09/10/2015 01:57:12 PM Eastern Daylight Time	08/05/2015 04:45:38 PM Eastern Daylight Time	08/05/2015 08:31:00 PM Eastern Daylight Time			09/10/2015 02:01:10 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	BlueMedicare Preferred HMO (HMO)	01	01		1			H1035	012	0	2016	Pinellas County		2		2			2							www.fhcp.com/medicare-directory-pinellas	www.fhcp.com/medicare-formulary-pinellas	www.fhcp.com/medicare-directory-pinellas	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(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			
H1035	801	0	1	01	01	H1035_801_0	2		1	05/25/2015	2016.01	05/25/2015 08:25:04 PM Eastern Daylight Time	07/10/2015 04:53:26 PM Eastern Daylight Time				07/16/2015 04:33:49 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	GRPMED (HMO)	01	01		1			H1035	801	0	2016	Florida		1	500	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;11a;11b;11c;12;16b;	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;12;16b;	1					2	2			
H1035	802	0	1	01	01	H1035_802_0	2		1	05/25/2015	2016.01	05/25/2015 08:34:54 PM Eastern Daylight Time	07/10/2015 04:54:12 PM Eastern Daylight Time				07/16/2015 04:33:49 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	GRPMED+ (HMO)	01	01		1			H1035	802	0	2016	Florida		1	500	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;11b;11c;12;16b;	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;12;16b;	1					2	2			
H1036	025	0	1	01	01	H1036_025_0	3		1	07/08/2015	2016.01	07/08/2015 07:50:48 AM Eastern Daylight Time	08/03/2015 10:21:59 AM Eastern Daylight Time	07/29/2015 08:58:24 PM Eastern Daylight Time			08/04/2015 01:13:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-025 (HMO)	01	01		1			H1036	025	0	2016	Hillsborough County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	040	0	1	01	01	H1036_040_0	3		1	07/08/2015	2016.01	07/08/2015 07:51:10 AM Eastern Daylight Time	08/03/2015 10:19:16 AM Eastern Daylight Time	07/29/2015 08:59:00 PM Eastern Daylight Time			08/04/2015 01:13:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-040 (HMO)	01	01		1			H1036	040	0	2016	Pasco County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4		1	07/08/2015	2016.01	07/08/2015 11:26:40 AM Eastern Daylight Time	08/03/2015 09:56:10 AM Eastern Daylight Time	07/29/2015 08:59:36 PM Eastern Daylight Time			08/04/2015 01:36:32 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-044 (HMO)	01	01		1			H1036	044	0	2016	Flagler and Volusia counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	052	0	1	01	01	H1036_052_0	3		1	07/08/2015	2016.01	07/08/2015 07:51:29 AM Eastern Daylight Time	08/03/2015 10:18:22 AM Eastern Daylight Time	07/29/2015 09:00:10 PM Eastern Daylight Time			08/04/2015 01:13:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-052 (HMO)	01	01		1			H1036	052	0	2016	Pinellas County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	053	0	1	01	01	H1036_053_0	3		1	07/08/2015	2016.01	07/08/2015 07:43:52 AM Eastern Daylight Time	05/25/2015 12:49:50 PM Eastern Daylight Time				07/11/2015 09:44:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-053A (HMO)	01	01		1			H1036	053	0	2016	Broward County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	054	0	1	01	01	H1036_054_0	4		1	07/08/2015	2016.01	07/08/2015 12:38:24 PM Eastern Daylight Time	07/31/2015 05:44:25 PM Eastern Daylight Time	07/29/2015 09:00:46 PM Eastern Daylight Time			08/04/2015 02:56:09 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-054C (HMO)	01	01		1			H1036	054	0	2016	Miami-Dade County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	056	0	1	01	01	H1036_056_0	3		1	07/08/2015	2016.01	07/08/2015 11:32:07 AM Eastern Daylight Time	05/25/2015 01:42:12 PM Eastern Daylight Time				07/11/2015 09:58:42 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-056 (HMO)	01	01		1			H1036	056	0	2016	Flagler and Volusia counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	062	0	1	01	01	H1036_062_0	4		1	07/08/2015	2016.01	07/08/2015 07:44:21 AM Eastern Daylight Time	07/31/2015 07:06:16 PM Eastern Daylight Time	07/29/2015 09:01:22 PM Eastern Daylight Time			08/04/2015 02:56:09 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-062C (HMO)	01	01		1			H1036	062	0	2016	Palm Beach County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	063	0	1	01	01	H1036_063_0	3		1	07/08/2015	2016.01	07/08/2015 07:44:48 AM Eastern Daylight Time	05/25/2015 12:50:45 PM Eastern Daylight Time				07/11/2015 09:44:59 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-063A (HMO)	01	01		1			H1036	063	0	2016	Palm Beach County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	065	0	1	01	01	H1036_065_0	5		1	07/14/2015	2016.01	07/14/2015 11:30:06 AM Eastern Daylight Time	07/31/2015 05:46:13 PM Eastern Daylight Time	07/29/2015 09:01:56 PM Eastern Daylight Time			08/04/2015 02:56:09 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-065C (HMO)	01	01		1			H1036	065	0	2016	Broward County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	067	0	1	01	01	H1036_067_0	3		1	07/08/2015	2016.01	07/08/2015 07:51:50 AM Eastern Daylight Time	08/03/2015 10:17:33 AM Eastern Daylight Time	07/29/2015 09:02:32 PM Eastern Daylight Time			08/04/2015 01:13:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-067 (HMO)	01	01		1			H1036	067	0	2016	Hernando County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4		1	07/08/2015	2016.01	07/08/2015 11:34:19 AM Eastern Daylight Time	08/03/2015 09:57:46 AM Eastern Daylight Time	07/29/2015 09:03:06 PM Eastern Daylight Time			08/04/2015 01:36:32 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-068 (HMO)	01	01		1			H1036	068	0	2016	Clay, Columbia, Putnam, and St. Johns counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 07:52:09 AM Eastern Daylight Time	08/03/2015 10:16:23 AM Eastern Daylight Time	07/29/2015 09:03:42 PM Eastern Daylight Time			08/04/2015 01:13:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-074 (HMO)	01	01		1			H1036	074	0	2016	Manatee County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	077	0	1	01	01	H1036_077_0	6	2	1	07/23/2015	2016.01	07/23/2015 03:14:49 PM Eastern Daylight Time	07/31/2015 06:34:40 PM Eastern Daylight Time	07/29/2015 09:04:18 PM Eastern Daylight Time			08/04/2015 02:56:09 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-077A (HMO SNP)	01	01		1			H1036	077	0	2016	Miami-Dade County		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	081	0	1	01	01	H1036_081_0	4		1	07/08/2015	2016.01	07/08/2015 11:37:55 AM Eastern Daylight Time	08/03/2015 09:57:09 AM Eastern Daylight Time	07/29/2015 09:04:54 PM Eastern Daylight Time			08/04/2015 01:36:32 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-081D (HMO)	01	01		1			H1036	081	0	2016	Baker, Duval and Nassau counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	2	1	07/08/2015	2016.01	07/08/2015 12:49:33 PM Eastern Daylight Time	08/03/2015 10:04:17 AM Eastern Daylight Time	07/29/2015 09:05:28 PM Eastern Daylight Time			08/04/2015 01:13:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-102 (HMO SNP)	01	01		1			H1036	102	0	2016	Tampa Metro Area		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	103	0	1	01	01	H1036_103_0	5	2	1	07/14/2015	2016.01	07/14/2015 11:31:34 AM Eastern Daylight Time	07/31/2015 06:29:12 PM Eastern Daylight Time	07/29/2015 09:06:04 PM Eastern Daylight Time			08/04/2015 02:56:09 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-103A (HMO SNP)	01	01		1			H1036	103	0	2016	Broward County		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	104	0	1	01	01	H1036_104_0	5	2	1	07/20/2015	2016.01	07/20/2015 04:40:57 PM Eastern Daylight Time	07/31/2015 06:40:39 PM Eastern Daylight Time	07/29/2015 09:06:38 PM Eastern Daylight Time			08/04/2015 02:56:09 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-104A (HMO SNP)	01	01		1			H1036	104	0	2016	Palm Beach County		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2		1	07/08/2015	2016.01	07/08/2015 07:52:30 AM Eastern Daylight Time	05/25/2015 01:34:32 PM Eastern Daylight Time				07/10/2015 01:21:19 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-119 (HMO)	01	01		1			H1036	119	0	2016	Tampa Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(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	5		1	07/14/2015	2016.01	07/14/2015 11:32:08 AM Eastern Daylight Time	07/31/2015 05:48:59 PM Eastern Daylight Time	07/29/2015 09:07:16 PM Eastern Daylight Time			08/04/2015 02:56:09 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	121	0	2016	Broward County		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	130	0	1	01	01	H1036_130_0	4		1	07/08/2015	2016.01	07/08/2015 07:45:29 AM Eastern Daylight Time	07/31/2015 05:51:11 PM Eastern Daylight Time	07/29/2015 09:07:50 PM Eastern Daylight Time			08/04/2015 02:56:09 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	130	0	2016	Palm Beach County		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	137	0	1	01	01	H1036_137_0	4		1	07/08/2015	2016.01	07/08/2015 12:45:34 PM Eastern Daylight Time	07/31/2015 04:30:31 PM Eastern Daylight Time	07/29/2015 09:08:26 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-137 (HMO)	01	01		1			H1036	137	0	2016	Charlotte Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	138	0	1	01	01	H1036_138_0	4		1	07/08/2015	2016.01	07/08/2015 09:58:24 AM Eastern Daylight Time	07/31/2015 04:28:29 PM Eastern Daylight Time	07/29/2015 09:09:02 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-138 (HMO)	01	01		1			H1036	138	0	2016	Greensboro / Winston-Salem Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 07:52:49 AM Eastern Daylight Time	08/03/2015 10:15:47 AM Eastern Daylight Time	07/29/2015 09:09:38 PM Eastern Daylight Time			08/04/2015 01:19:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-140 (HMO)	01	01		1			H1036	140	0	2016	Citrus County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	141	0	1	01	01	H1036_141_0	3		1	07/08/2015	2016.01	07/08/2015 07:53:07 AM Eastern Daylight Time	08/03/2015 10:14:40 AM Eastern Daylight Time	07/29/2015 09:10:12 PM Eastern Daylight Time			08/04/2015 01:19:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-141 (HMO)	01	01		1			H1036	141	0	2016	Tampa Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4		1	07/08/2015	2016.01	07/08/2015 11:40:04 AM Eastern Daylight Time	08/03/2015 09:55:23 AM Eastern Daylight Time	07/29/2015 09:10:48 PM Eastern Daylight Time			08/04/2015 01:36:32 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-143 (HMO)	01	01		1			H1036	143	0	2016	Escambia and Santa Rosa counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 07:38:26 AM Eastern Daylight Time	08/03/2015 10:14:00 AM Eastern Daylight Time	07/29/2015 09:11:24 PM Eastern Daylight Time			08/04/2015 02:01:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-146 (HMO)	01	01		1			H1036	146	0	2016	Orange, Osceola and Seminole counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 03:04:25 PM Eastern Daylight Time	08/03/2015 02:08:20 PM Eastern Daylight Time	07/29/2015 09:11:58 PM Eastern Daylight Time			08/04/2015 01:35:49 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-151 (HMO)	01	01		1			H1036	151	0	2016	Jackson Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 12:21:40 PM Eastern Daylight Time	08/03/2015 11:22:34 AM Eastern Daylight Time	07/29/2015 09:12:34 PM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-153 (HMO)	01	01		1			H1036	153	0	2016	Clackamas, Multnomah and Washington counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	156	0	1	01	01	H1036_156_0	5		1	07/08/2015	2016.01	07/08/2015 11:42:41 AM Eastern Daylight Time	08/03/2015 09:54:39 AM Eastern Daylight Time	07/29/2015 09:13:10 PM Eastern Daylight Time			08/04/2015 01:36:32 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	156	0	2016	Flagler and Volusia counties		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	157	0	1	01	01	H1036_157_0	4		1	07/08/2015	2016.01	07/08/2015 11:45:05 AM Eastern Daylight Time	08/03/2015 09:53:45 AM Eastern Daylight Time	07/29/2015 09:13:46 PM Eastern Daylight Time			08/04/2015 01:36:32 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-157 (HMO)	01	01		1			H1036	157	0	2016	Flagler and Volusia counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 07:53:30 AM Eastern Daylight Time	08/03/2015 10:13:19 AM Eastern Daylight Time	07/29/2015 09:14:22 PM Eastern Daylight Time			08/04/2015 01:19:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	160	0	2016	Tampa Metro Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	167	0	1	01	01	H1036_167_0	4	2	1	07/31/2015	2016.01	07/31/2015 12:49:29 PM Eastern Daylight Time	07/31/2015 04:28:58 PM Eastern Daylight Time	07/29/2015 09:14:56 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-167 (HMO SNP)	01	01		1			H1036	167	0	2016	Charlotte Metro Area		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	168	0	1	01	01	H1036_168_0	4	2	1	07/31/2015	2016.01	07/31/2015 12:50:24 PM Eastern Daylight Time	08/01/2015 11:46:38 AM Eastern Daylight Time	07/29/2015 09:15:32 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-168 (HMO SNP)	01	01		1			H1036	168	0	2016	Greensboro / Winston-Salem Metro Area		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 03:04:56 PM Eastern Daylight Time	08/03/2015 02:26:52 PM Eastern Daylight Time	07/29/2015 09:16:08 PM Eastern Daylight Time			08/04/2015 01:35:49 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-171 (HMO)	01	01		1			H1036	171	0	2016	Gulf Coast Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 11:47:07 AM Eastern Daylight Time	08/03/2015 09:53:02 AM Eastern Daylight Time	07/29/2015 09:16:42 PM Eastern Daylight Time			08/04/2015 01:36:32 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	175	0	2016	Jacksonville Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	178	0	1	01	01	H1036_178_0	4		1	07/14/2015	2016.01	07/14/2015 10:17:51 AM Eastern Daylight Time	08/03/2015 02:19:45 PM Eastern Daylight Time	07/29/2015 09:17:18 PM Eastern Daylight Time			08/04/2015 01:35:49 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	178	0	2016	Gulf Coast Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	179	0	1	01	01	H1036_179_0	4		1	07/14/2015	2016.01	07/14/2015 10:18:08 AM Eastern Daylight Time	08/03/2015 02:21:05 PM Eastern Daylight Time	07/29/2015 09:17:52 PM Eastern Daylight Time			08/04/2015 01:35:49 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	179	0	2016	Jackson Metro Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	184	0	1	01	01	H1036_184_0	5		1	07/14/2015	2016.01	07/14/2015 11:31:56 AM Eastern Daylight Time	07/31/2015 05:36:31 PM Eastern Daylight Time	07/29/2015 09:18:28 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H1036	184	0	2016	Charlotte Metro Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	186	0	1	01	01	H1036_186_0	5		1	07/14/2015	2016.01	07/14/2015 11:32:39 AM Eastern Daylight Time	07/31/2015 06:10:23 PM Eastern Daylight Time	07/29/2015 09:19:04 PM Eastern Daylight Time			08/04/2015 03:03:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Heart (HMO SNP)	01	01		1			H1036	186	0	2016	Broward County		2		2			1	4		1		00000000000000010000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	188	0	1	01	01	H1036_188_0	5		1	07/14/2015	2016.01	07/14/2015 11:33:14 AM Eastern Daylight Time	07/31/2015 06:13:38 PM Eastern Daylight Time	07/29/2015 09:19:40 PM Eastern Daylight Time			08/04/2015 03:03:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	188	0	2016	Miami-Dade County		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	189	0	1	01	01	H1036_189_0	6		1	07/14/2015	2016.01	07/14/2015 11:33:44 AM Eastern Daylight Time	07/31/2015 06:15:37 PM Eastern Daylight Time	07/29/2015 09:20:16 PM Eastern Daylight Time			08/04/2015 03:03:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Heart (HMO SNP)	01	01		1			H1036	189	0	2016	Miami-Dade County		2		2			1	4		1		00000000000000010000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	193	0	1	01	01	H1036_193_0	3		1	07/08/2015	2016.01	07/08/2015 07:38:58 AM Eastern Daylight Time	08/03/2015 10:12:30 AM Eastern Daylight Time	07/29/2015 09:20:52 PM Eastern Daylight Time			08/04/2015 02:01:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	193	0	2016	Orange, Osceola and Seminole counties		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	194	0	1	01	01	H1036_194_0	3		1	07/08/2015	2016.01	07/08/2015 11:49:20 AM Eastern Daylight Time	08/03/2015 09:51:56 AM Eastern Daylight Time	07/29/2015 09:21:26 PM Eastern Daylight Time			08/04/2015 01:42:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1036	194	0	2016	Escambia and Santa Rosa counties		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	196	0	1	01	01	H1036_196_0	3		1	07/08/2015	2016.01	07/08/2015 07:39:40 AM Eastern Daylight Time	08/03/2015 10:10:53 AM Eastern Daylight Time	07/29/2015 09:22:02 PM Eastern Daylight Time			08/04/2015 02:01:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-196 (HMO)	01	01		1			H1036	196	0	2016	Charlotte County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	199	0	1	01	01	H1036_199_0	4		1	07/08/2015	2016.01	07/08/2015 10:18:33 AM Eastern Daylight Time	07/31/2015 07:00:24 PM Eastern Daylight Time	07/29/2015 09:22:36 PM Eastern Daylight Time			08/04/2015 03:03:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-199 (HMO)	01	01		1			H1036	199	0	2016	Palm Beach County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	07/08/2015	2016.01	07/08/2015 12:51:40 PM Eastern Daylight Time	08/03/2015 09:48:10 AM Eastern Daylight Time	07/29/2015 09:23:12 PM Eastern Daylight Time			08/04/2015 01:42:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-209 (HMO SNP)	01	01		1			H1036	209	0	2016	Flagler and Volusia counties		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	07/08/2015	2016.01	07/08/2015 12:55:37 PM Eastern Daylight Time	08/03/2015 09:46:58 AM Eastern Daylight Time	07/29/2015 09:23:48 PM Eastern Daylight Time			08/04/2015 01:42:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-210 (HMO SNP)	01	01		1			H1036	210	0	2016	Jacksonville Area		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	07/08/2015	2016.01	07/08/2015 01:35:04 PM Eastern Daylight Time	08/03/2015 10:22:40 AM Eastern Daylight Time	07/29/2015 09:24:24 PM Eastern Daylight Time			08/04/2015 02:01:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-213 (HMO SNP)	01	01		1			H1036	213	0	2016	Orange, Osceola and Seminole counties		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	07/08/2015	2016.01	07/08/2015 01:21:14 PM Eastern Daylight Time	08/03/2015 09:50:14 AM Eastern Daylight Time	07/29/2015 09:24:58 PM Eastern Daylight Time			08/04/2015 01:42:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-214 (HMO SNP)	01	01		1			H1036	214	0	2016	Select Counties in Florida		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	215	0	1	01	01	H1036_215_0	3		1	07/08/2015	2016.01	07/08/2015 07:54:03 AM Eastern Daylight Time	08/03/2015 10:10:12 AM Eastern Daylight Time	07/29/2015 09:25:34 PM Eastern Daylight Time			08/04/2015 01:19:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-215 (HMO)	01	01		1			H1036	215	0	2016	Sarasota County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 07:40:28 AM Eastern Daylight Time	08/03/2015 10:09:32 AM Eastern Daylight Time	07/29/2015 09:26:10 PM Eastern Daylight Time			08/04/2015 02:01:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-217 (HMO)	01	01		1			H1036	217	0	2016	Lee County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	218	0	1	01	01	H1036_218_0	3		1	07/08/2015	2016.01	07/08/2015 07:40:59 AM Eastern Daylight Time	08/03/2015 10:07:43 AM Eastern Daylight Time	07/29/2015 09:26:46 PM Eastern Daylight Time			08/04/2015 02:01:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-218 (HMO)	01	01		1			H1036	218	0	2016	Collier County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 12:16:27 PM Eastern Daylight Time	08/03/2015 11:25:44 AM Eastern Daylight Time	07/29/2015 09:27:22 PM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-219 (HMO)	01	01		1			H1036	219	0	2016	Deschutes and Jefferson counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	2	1	07/31/2015	2016.01	07/31/2015 01:43:33 PM Eastern Daylight Time	08/03/2015 02:41:24 PM Eastern Daylight Time	07/29/2015 09:27:56 PM Eastern Daylight Time			08/04/2015 01:35:49 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-222 (HMO SNP)	01	01		1			H1036	222	0	2016	Select Counties in Mississippi		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/07/2015	2016.01	07/07/2015 04:15:08 PM Eastern Daylight Time	08/03/2015 02:28:19 PM Eastern Daylight Time	07/29/2015 09:28:32 PM Eastern Daylight Time			08/04/2015 01:35:49 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-223 (HMO)	01	01		1			H1036	223	0	2016	DeSoto County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	226	0	1	01	01	H1036_226_0	3	2	1	07/08/2015	2016.01	07/08/2015 01:38:04 PM Eastern Daylight Time	07/31/2015 06:46:14 PM Eastern Daylight Time	07/29/2015 09:29:08 PM Eastern Daylight Time			08/04/2015 02:11:12 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-226 (HMO SNP)	01	01		1			H1036	226	0	2016	Glades, Martin, Okeechobee and St. Lucie counties		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	227	0	1	01	01	H1036_227_0	3		1	07/08/2015	2016.01	07/08/2015 07:34:43 AM Eastern Daylight Time	07/31/2015 06:19:05 PM Eastern Daylight Time	07/29/2015 09:29:44 PM Eastern Daylight Time			08/04/2015 02:11:12 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H1036	227	0	2016	Glades, Martin, Okeechobee and St. Lucie counties		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 07:35:19 AM Eastern Daylight Time	08/03/2015 09:12:44 AM Eastern Daylight Time	07/29/2015 09:30:18 PM Eastern Daylight Time			08/04/2015 02:11:12 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-229 (HMO)	01	01		1			H1036	229	0	2016	Glades, Martin, Okeechobee and St. Lucie counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 07:55:08 AM Eastern Daylight Time	08/03/2015 10:06:52 AM Eastern Daylight Time	07/29/2015 09:30:54 PM Eastern Daylight Time			08/04/2015 01:19:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-230 (HMO)	01	01		1			H1036	230	0	2016	Hardee, Highlands and Polk counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	07/08/2015	2016.01	07/08/2015 12:52:10 PM Eastern Daylight Time	08/03/2015 10:02:57 AM Eastern Daylight Time	07/29/2015 09:31:30 PM Eastern Daylight Time			08/04/2015 01:19:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-231 (HMO SNP)	01	01		1			H1036	231	0	2016	Hardee, Highlands and Polk counties		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	233	0	1	01	01	H1036_233_0	4		1	07/08/2015	2016.01	07/08/2015 10:01:01 AM Eastern Daylight Time	07/31/2015 04:31:01 PM Eastern Daylight Time	07/30/2015 11:19:56 AM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-233 (HMO)	01	01		1			H1036	233	0	2016	Raleigh Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/14/2015	2016.01	07/14/2015 10:30:19 AM Eastern Daylight Time	07/31/2015 05:18:00 PM Eastern Daylight Time	07/30/2015 11:20:34 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Community HMO Diabetes and Heart (HMO SNP)	01	01		1			H1036	234	0	2016	Jefferson County		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	2	1	07/31/2015	2016.01	07/31/2015 01:40:23 PM Eastern Daylight Time	07/31/2015 05:18:19 PM Eastern Daylight Time	07/30/2015 11:21:12 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Community HMO SNP-DE (HMO SNP)	01	01		1			H1036	235	0	2016	Jefferson County		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	236	0	1	01	01	H1036_236_0	4		1	07/22/2015	2016.01	07/22/2015 08:24:28 AM Eastern Daylight Time	07/31/2015 05:17:40 PM Eastern Daylight Time	07/30/2015 11:21:48 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Community HMO (HMO)	01	01		1			H1036	236	0	2016	Jefferson County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	237	1	1	01	01	H1036_237_1	4		1	07/08/2015	2016.01	07/08/2015 07:46:37 AM Eastern Daylight Time	07/31/2015 06:52:51 PM Eastern Daylight Time	07/29/2015 09:34:28 PM Eastern Daylight Time			08/04/2015 03:03:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-237 (HMO)	01	01		1			H1036	237	1	2016	South Florida: Broward or Miami-Dade	South Florida- Broward	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	237	2	1	01	01	H1036_237_2	4		1	07/08/2015	2016.01	07/08/2015 07:46:49 AM Eastern Daylight Time	07/31/2015 07:19:39 PM Eastern Daylight Time	07/29/2015 09:35:02 PM Eastern Daylight Time			08/04/2015 03:03:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-237 (HMO)	01	01		1			H1036	237	2	2016	South Florida: Broward or Miami-Dade	South Florida- Miami-Dade	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	239	0	1	01	01	H1036_239_0	4	2	1	07/31/2015	2016.01	07/31/2015 12:51:58 PM Eastern Daylight Time	07/31/2015 04:33:04 PM Eastern Daylight Time	07/29/2015 09:35:38 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-239 (HMO SNP)	01	01		1			H1036	239	0	2016	Raleigh Metro Area		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	240	0	1	01	01	H1036_240_0	5		1	07/14/2015	2016.01	07/14/2015 11:34:53 AM Eastern Daylight Time	07/31/2015 04:32:33 PM Eastern Daylight Time	07/29/2015 09:36:14 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H1036	240	0	2016	Raleigh Metro Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	241	0	1	01	01	H1036_241_0	3	2	1	07/08/2015	2016.01	07/08/2015 01:24:04 PM Eastern Daylight Time	08/03/2015 09:48:54 AM Eastern Daylight Time	07/29/2015 09:36:48 PM Eastern Daylight Time			08/04/2015 01:42:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-241 (HMO SNP)	01	01		1			H1036	241	0	2016	Flagler and Volusia counties		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	243	0	1	01	01	H1036_243_0	3	2	1	07/08/2015	2016.01	07/08/2015 01:27:28 PM Eastern Daylight Time	08/03/2015 09:47:35 AM Eastern Daylight Time	07/29/2015 09:37:24 PM Eastern Daylight Time			08/04/2015 01:42:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-243 (HMO SNP)	01	01		1			H1036	243	0	2016	Jacksonville Area		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	245	0	1	01	01	H1036_245_0	3	2	1	07/08/2015	2016.01	07/08/2015 01:30:40 PM Eastern Daylight Time	08/03/2015 09:49:38 AM Eastern Daylight Time	07/29/2015 09:38:00 PM Eastern Daylight Time			08/04/2015 01:42:37 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-245 (HMO SNP)	01	01		1			H1036	245	0	2016	Select Counties in Florida		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	247	0	1	01	01	H1036_247_0	3	2	1	07/08/2015	2016.01	07/08/2015 01:41:53 PM Eastern Daylight Time	08/03/2015 10:02:10 AM Eastern Daylight Time	07/29/2015 09:38:36 PM Eastern Daylight Time			08/04/2015 02:01:40 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-247 (HMO SNP)	01	01		1			H1036	247	0	2016	Orange, Osceola and Seminole counties		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	249	0	1	01	01	H1036_249_0	3	2	1	07/08/2015	2016.01	07/08/2015 01:45:31 PM Eastern Daylight Time	07/31/2015 06:43:37 PM Eastern Daylight Time	07/29/2015 09:39:10 PM Eastern Daylight Time			08/04/2015 02:11:12 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-249 (HMO SNP)	01	01		1			H1036	249	0	2016	Glades, Martin, Okeechobee and St. Lucie counties		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	251	0	1	01	01	H1036_251_0	3	2	1	07/08/2015	2016.01	07/08/2015 12:54:44 PM Eastern Daylight Time	08/03/2015 10:05:11 AM Eastern Daylight Time	07/29/2015 09:39:46 PM Eastern Daylight Time			08/04/2015 01:19:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-251 (HMO SNP)	01	01		1			H1036	251	0	2016	Tampa Metro Area		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	253	0	1	01	01	H1036_253_0	3	2	1	07/08/2015	2016.01	07/08/2015 12:56:58 PM Eastern Daylight Time	08/03/2015 10:03:38 AM Eastern Daylight Time	07/29/2015 09:40:22 PM Eastern Daylight Time			08/04/2015 01:19:04 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-253 (HMO SNP)	01	01		1			H1036	253	0	2016	Hardee, Highlands and Polk counties		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	255	0	1	01	01	H1036_255_0	6	2	1	07/22/2015	2016.01	07/22/2015 04:09:38 PM Eastern Daylight Time	07/31/2015 06:26:30 PM Eastern Daylight Time	07/29/2015 09:40:56 PM Eastern Daylight Time			08/04/2015 03:03:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-255 (HMO SNP)	01	01		1			H1036	255	0	2016	Broward County		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	257	0	1	01	01	H1036_257_0	6	2	1	07/22/2015	2016.01	07/22/2015 04:09:52 PM Eastern Daylight Time	07/31/2015 06:32:04 PM Eastern Daylight Time	07/29/2015 09:41:32 PM Eastern Daylight Time			08/04/2015 03:03:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-257 (HMO SNP)	01	01		1			H1036	257	0	2016	Miami-Dade County		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	259	0	1	01	01	H1036_259_0	5	2	1	07/20/2015	2016.01	07/20/2015 04:42:33 PM Eastern Daylight Time	07/31/2015 06:37:42 PM Eastern Daylight Time	07/29/2015 09:42:08 PM Eastern Daylight Time			08/04/2015 03:03:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-259 (HMO SNP)	01	01		1			H1036	259	0	2016	Palm Beach County		2		2			1	3		1	4			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	801	0	1	01	01	H1036_801_0	1		1	05/11/2015	2016.01	05/11/2015 01:56:26 PM Eastern Daylight Time	05/29/2015 08:09:16 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	801	0	2016	Select counties in Florida		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1036	806	0	1	01	01	H1036_806_0	1		1	05/11/2015	2016.01	05/11/2015 01:57:31 PM Eastern Daylight Time	05/29/2015 08:15:05 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	806	0	2016	Select counties in Florida		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1036	809	0	1	01	01	H1036_809_0	1		1	05/11/2015	2016.01	05/11/2015 01:58:37 PM Eastern Daylight Time	05/29/2015 08:22:07 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	809	0	2016	Select counties in Florida		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1036	810	0	1	01	01	H1036_810_0	1		1	05/11/2015	2016.01	05/11/2015 01:59:40 PM Eastern Daylight Time	05/29/2015 08:26:26 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	810	0	2016	Select Counties in MS, OR and NC		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1036	811	0	1	01	01	H1036_811_0	1		1	05/11/2015	2016.01	05/11/2015 02:00:38 PM Eastern Daylight Time	05/29/2015 08:26:55 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	811	0	2016	Select Counties in MS, OR and NC		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1043	001	0	1	20	08	H1043_001_0	2		1	05/26/2015	2016.01	05/26/2015 04:50:37 PM Eastern Daylight Time		05/26/2015 10:52:17 AM Eastern Daylight Time			05/26/2015 05:28:11 PM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	www.floridapace.org	Florida PACE Centers, Inc. (PACE)	08	20		1			H1043	001	0	2016	Florida PACE Centers, Inc.		2		2			2								www.noformulary.com	www.floridapace.org									(305)262-7842		(305)751-7223		(305)262-7842		(305)751-7223										(305)262-7842		(305)751-7223	2246	(305)262-7842		(305)751-7223																
H1043	002	0	1	20	08	H1043_002_0	2		1	05/26/2015	2016.01	05/26/2015 04:51:43 PM Eastern Daylight Time		05/26/2015 11:53:09 AM Eastern Daylight Time			05/26/2015 05:28:11 PM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	www.floridapace.org	Florida PACE Centers, Inc (PACE)	08	20		1			H1043	002	0	2016	Florida PACE Centers, Inc.		2		2			2								www.noformulary.com	www.floridapace.org									(305)262-7842	2246	(305)751-7223		(305)262-7842		(305)751-7223										(305)262-7842		(305)751-7223		(305)262-7842		(305)751-7223																
H1045	001	0	1	02	01	H1045_001_0	6		1	08/07/2015	2016.01	08/07/2015 10:50:15 AM Central Daylight Time	07/31/2015 01:56:37 PM Central Daylight Time	07/30/2015 07:24:18 AM Central Daylight Time			08/07/2015 11:07:40 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Choice Dade (HMO-POS)	01	02		1			H1045	001	0	2016	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	4		1	08/07/2015	2016.01	08/07/2015 10:50:27 AM Central Daylight Time	07/31/2015 01:57:07 PM Central Daylight Time	07/30/2015 07:25:04 AM Central Daylight Time			08/07/2015 11:07:40 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Choice Broward (HMO)	01	01		1			H1045	005	0	2016	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	4	2	1	07/31/2015	2016.01	07/31/2015 12:50:10 PM Central Daylight Time	07/31/2015 01:57:36 PM Central Daylight Time	07/30/2015 07:25:49 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Medicare Assist (HMO SNP)	01	01		1			H1045	012	0	2016	Miami-Dade and Broward Counties		2		2			1	3		1	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	016	0	1	01	01	H1045_016_0	5		1	07/31/2015	2016.01	07/31/2015 12:50:30 PM Central Daylight Time	07/31/2015 01:58:06 PM Central Daylight Time	07/30/2015 07:26:38 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Complete Care (HMO)	01	01		1			H1045	016	0	2016	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	018	0	1	01	01	H1045_018_0	5		1	07/31/2015	2016.01	07/31/2015 12:51:49 PM Central Daylight Time	07/31/2015 01:58:36 PM Central Daylight Time	07/30/2015 07:27:23 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Special Care Miami-Dade (HMO SNP)	01	01		1			H1045	018	0	2016	Miami-Dade County		2		2			1	4		1		00000000000000000010		www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	023	0	1	01	01	H1045_023_0	3		1	08/07/2015	2016.01	08/07/2015 10:50:54 AM Central Daylight Time	07/31/2015 01:59:07 PM Central Daylight Time	07/30/2015 07:28:06 AM Central Daylight Time			08/07/2015 11:07:40 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Secure Option (HMO)	01	01		1			H1045	023	0	2016	Central Florida		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	025	0	1	01	01	H1045_025_0	3		1	07/31/2015	2016.01	07/31/2015 12:56:23 PM Central Daylight Time	07/31/2015 01:59:37 PM Central Daylight Time	07/30/2015 07:28:53 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages MedicareComplete 1 (HMO)	01	01		1			H1045	025	0	2016	Lake, Marion and Sumter counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	026	0	1	01	01	H1045_026_0	3		1	07/31/2015	2016.01	07/31/2015 12:58:05 PM Central Daylight Time	07/31/2015 02:00:07 PM Central Daylight Time	07/30/2015 07:29:37 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H1045	026	0	2016	Clay and Duval 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	027	0	1	01	01	H1045_027_0	3		1	07/31/2015	2016.01	07/31/2015 12:59:16 PM Central Daylight Time	07/31/2015 02:00:38 PM Central Daylight Time	07/30/2015 07:30:23 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages MedicareComplete 2 (HMO)	01	01		1			H1045	027	0	2016	Lake, Marion and Sumter counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	028	0	1	01	01	H1045_028_0	3		1	07/31/2015	2016.01	07/31/2015 01:00:06 PM Central Daylight Time	07/31/2015 02:01:08 PM Central Daylight Time	07/30/2015 07:31:10 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	028	0	2016	Tampa 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	1	01	7a;7g;	
H1045	029	0	1	01	01	H1045_029_0	3		1	07/31/2015	2016.01	07/31/2015 01:01:10 PM Central Daylight Time	07/31/2015 02:01:38 PM Central Daylight Time	07/30/2015 07:31:58 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	029	0	2016	St Lucie 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	1	01	7a;7g;	
H1045	030	0	1	01	01	H1045_030_0	3		1	07/31/2015	2016.01	07/31/2015 01:02:03 PM Central Daylight Time	07/31/2015 02:02:08 PM Central Daylight Time	07/30/2015 07:32:49 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	030	0	2016	Brevard, Orange, Osceola and Seminole counties		2		2			2							www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;7g;	
H1045	031	0	1	01	01	H1045_031_0	3		1	07/31/2015	2016.01	07/31/2015 01:04:47 PM Central Daylight Time	07/31/2015 02:02:38 PM Central Daylight Time	07/30/2015 07:33:38 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	031	0	2016	Escambia, Okaloosa abd Santa Rosa counties		2		2			2							www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	032	0	1	01	01	H1045_032_0	3		1	07/31/2015	2016.01	07/31/2015 01:12:43 PM Central Daylight Time	07/31/2015 02:03:08 PM Central Daylight Time	07/30/2015 07:34:26 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	032	0	2016	Bay and Walton counties		2		2			2							www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	033	0	1	01	01	H1045_033_0	3		1	07/31/2015	2016.01	07/31/2015 01:13:47 PM Central Daylight Time	07/31/2015 02:03:38 PM Central Daylight Time	07/30/2015 07:35:15 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	033	0	2016	Alachua and Columbia counties		2		2			2							www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	034	0	1	01	01	H1045_034_0	3		1	07/31/2015	2016.01	07/31/2015 01:14:44 PM Central Daylight Time	08/04/2015 09:58:32 AM Central Daylight Time	07/30/2015 07:36:02 AM Central Daylight Time			08/04/2015 10:44:41 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	mypreferredcare.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1045	034	0	2016	Collier and Lee county		2		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(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	035	0	1	01	01	H1045_035_0	3		1	07/31/2015	2016.01	07/31/2015 01:17:06 PM Central Daylight Time	07/31/2015 02:04:38 PM Central Daylight Time	07/30/2015 07:36:53 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1045	035	0	2016	Flagler, Putnam and St. Johns counties		2		2			2							www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	036	0	1	01	01	H1045_036_0	3		1	07/31/2015	2016.01	07/31/2015 03:21:45 PM Central Daylight Time	07/31/2015 02:05:08 PM Central Daylight Time	07/30/2015 07:37:44 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H1045	036	0	2016	Indian River, Martin and St. Lucie counties		2		2			2							www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	037	0	1	01	01	H1045_037_0	5		1	08/07/2015	2016.01	08/07/2015 10:51:12 AM Central Daylight Time	07/31/2015 02:05:38 PM Central Daylight Time	07/30/2015 07:38:27 AM Central Daylight Time			08/07/2015 11:07:40 AM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Choice Palm Beach (HMO)	01	01		1			H1045	037	0	2016	Palm Beach county		2		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	038	0	1	01	01	H1045_038_0	4	2	1	07/31/2015	2016.01	07/31/2015 01:32:53 PM Central Daylight Time	07/31/2015 02:06:08 PM Central Daylight Time	07/30/2015 07:39:10 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	mypreferredcare.com	Preferred Medicare Assist Palm Beach (HMO SNP)	01	01		1			H1045	038	0	2016	Palm Beach county		2		2			1	3		1	2			www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	039	0	1	01	01	H1045_039_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:26:18 AM Central Daylight Time	07/31/2015 02:06:38 PM Central Daylight Time	07/30/2015 07:40:04 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO SNP)	01	01		1			H1045	039	0	2016	Florida		2		2			1	3		1	2			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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			
H1045	040	0	1	01	01	H1045_040_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:26:13 AM Central Daylight Time	07/31/2015 02:07:08 PM Central Daylight Time	07/30/2015 07:41:00 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO SNP)	01	01		1			H1045	040	0	2016	Orange County		2		2			1	3		1	2			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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			
H1045	801	0	1	01	01	H1045_801_0	1		1	05/29/2015	2016.01	05/29/2015 06:43:30 PM Central Daylight Time	05/30/2015 02:29:43 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	mypreferredcare.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	801	0	2016	Select counties in Florida		1		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H1045	802	0	1	01	01	H1045_802_0	1		1	05/29/2015	2016.01	05/29/2015 06:44:58 PM Central Daylight Time	05/30/2015 02:30:14 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	mypreferredcare.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	802	0	2016	Select counties in Florida		1		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H1045	803	0	1	01	01	H1045_803_0	1		1	05/29/2015	2016.01	05/29/2015 06:45:44 PM Central Daylight Time	05/30/2015 02:30:45 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	mypreferredcare.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1045	803	0	2016	Select counties in Florida		1		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H1045	804	0	2	01	01	H1045_804_0	1		1	05/29/2015	2016.01	05/29/2015 06:46:32 PM Central Daylight Time	05/30/2015 02:31:17 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	PREFERRED CARE PARTNERS, INC.	Preferred Care Partners, Inc.	mypreferredcare.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1045	804	0	2016	Select counties in Florida		1		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H1099	001	0	1	02	01	H1099_001_0	9		1	08/04/2015	2016.01	08/04/2015 03:53:34 PM Eastern Daylight Time	08/10/2015 02:52:39 PM Eastern Daylight Time	07/30/2015 10:23:50 AM Eastern Daylight Time			08/10/2015 04:34:59 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	2016	Brevard and Indian River Counties		2	139669	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	6		1	08/03/2015	2016.01	08/03/2015 04:56:25 PM Eastern Daylight Time	08/04/2015 02:06:16 PM Eastern Daylight Time	07/30/2015 10:26:54 AM Eastern Daylight Time			08/05/2015 04:43:07 AM 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	2016	Brevard and Indian River Counties		2	103363	2			2							myHFHP.org	myHFHP.org	myHFHP.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2	2			
H1099	009	0	1	01	01	H1099_009_0	3		1	07/02/2015	2016.01	07/02/2015 04:08:09 PM Eastern Daylight Time	07/02/2015 04:38:05 PM Eastern Daylight Time				07/02/2015 04:49:36 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	2016	Brevard and Indian River Counties		2	2797	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	6		1	08/03/2015	2016.01	08/03/2015 04:54:58 PM Eastern Daylight Time	08/04/2015 03:04:12 PM Eastern Daylight Time	07/30/2015 10:27:44 AM Eastern Daylight Time			08/05/2015 04:43:07 AM 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	2016	Brevard and Indian River Counties		2	80440	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	02	01	H1099_016_0	7		1	08/03/2015	2016.01	08/03/2015 04:14:17 PM Eastern Daylight Time	08/04/2015 06:32:00 PM Eastern Daylight Time	07/30/2015 10:30:04 AM Eastern Daylight Time			08/05/2015 04:43:07 AM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myFHCA.org	Florida Hospital SunSaver Plan (HMO-POS)	01	02		1			H1099	016	0	2016	Volusia, Flagler, Hardee, and Highlands Counties		2	62387	2			2							myFHCA.org	myFHCA.org	myFHCA.org	(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2	2			
H1099	017	0	1	02	01	H1099_017_0	7		1	08/03/2015	2016.01	08/03/2015 04:15:38 PM Eastern Daylight Time	08/10/2015 02:52:30 PM Eastern Daylight Time	07/30/2015 10:31:00 AM Eastern Daylight Time			08/10/2015 04:34:59 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myFHCA.org	Florida Hospital Explorer Plan (HMO-POS)	01	02		1			H1099	017	0	2016	Volusia, Flagler, Hardee, and Highlands Counties		2	11881	2			2							myFHCA.org	myFHCA.org	myFHCA.org	(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2	2			
H1099	802	0	1	01	01	H1099_802_0	2		1	06/01/2015	2016.01	06/01/2015 09:26:24 AM Eastern Daylight Time	06/01/2015 05:34:13 PM Eastern Daylight Time				06/01/2015 05:56:49 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myHFHP.org	EMPLOYER GROUP PLUS (HMO)	01	01		1			H1099	802	0	2016	Central Florida Area		1	12377	2			2							myHFHP.org	myHFHP.org	myHFHP.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		1	2		2		1					1	2			
H1099	804	0	1	02	01	H1099_804_0	2		1	06/01/2015	2016.01	06/01/2015 09:27:37 AM Eastern Daylight Time	06/01/2015 05:34:14 PM Eastern Daylight Time				06/01/2015 05:57:21 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	myHFHP.org	EMPLOYER GROUP POS (HMO-POS)	01	02		1			H1099	804	0	2016	Central Florida Area		1	1155	2			2							myHFHP.org	myHFHP.org	myHFHP.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		1	2		2		1	2		2		1	2			
H1109	005	0	1	01	01	H1109_005_0	7		1	07/31/2015	2016.01	07/31/2015 10:57:01 AM Eastern Daylight Time	07/31/2015 10:44:12 AM Eastern Daylight Time	07/29/2015 04:58:39 PM Eastern Daylight Time			08/01/2015 05:48:36 PM Eastern Daylight Time	AETNA HEALTH INC.(GEORGIA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1109	005	0	2016	Atlanta and Surrounding Counties		2	100	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1109	801	0	1	01	01	H1109_801_0	2		1	05/29/2015	2016.01	05/29/2015 12:11:05 PM Eastern Daylight Time	07/16/2015 05:22:56 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH INC.(GEORGIA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H1109	801	0	2016	Georgia		1	102	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1	2			
H1109	802	0	1	01	01	H1109_802_0	2		1	05/29/2015	2016.01	05/29/2015 12:11:18 PM Eastern Daylight Time	07/16/2015 05:22:57 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH INC.(GEORGIA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H1109	802	0	2016	Georgia		1	725	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H1111	006	0	1	01	01	H1111_006_0	3		1	07/31/2015	2016.01	07/31/2015 01:33:47 PM Central Daylight Time	07/31/2015 02:05:20 PM Central Daylight Time	07/30/2015 07:43:27 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1111	006	0	2016	Select counties in Georgia		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1111	007	0	1	01	01	H1111_007_0	3		1	07/31/2015	2016.01	07/31/2015 01:34:35 PM Central Daylight Time	07/31/2015 02:05:45 PM Central Daylight Time	07/30/2015 07:44:10 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1111	007	0	2016	Select counties in Georgia		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1111	801	0	1	01	01	H1111_801_0	1		1	04/13/2015	2016.01	04/13/2015 11:12:57 AM Central Daylight Time	05/29/2015 02:50:09 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	801	0	2016	GA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H1111	804	0	1	01	01	H1111_804_0	1		1	04/13/2015	2016.01	04/13/2015 11:13:31 AM Central Daylight Time	05/29/2015 02:54:02 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	804	0	2016	GA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H1111	805	0	1	01	01	H1111_805_0	1		1	04/13/2015	2016.01	04/13/2015 11:14:11 AM Central Daylight Time	05/29/2015 02:54:28 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	805	0	2016	GA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H1111	807	0	2	01	01	H1111_807_0	1		1	04/13/2015	2016.01	04/13/2015 11:14:49 AM Central Daylight Time	05/29/2015 02:55:57 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1111	807	0	2016	GA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H1112	006	0	1	01	01	H1112_006_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:23:23 PM Eastern Daylight Time	08/03/2015 01:29:40 PM Eastern Daylight Time	08/03/2015 03:46:42 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1112	006	0	2016	Select Counties in GA		2	14464	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3361		(866)482-3361		(866)527-0056		(866)527-0056		(866)482-3361		(866)482-3361		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1112	027	0	1	01	01	H1112_027_0	5		1	08/01/2015	2016.01	08/01/2015 09:37:04 AM Eastern Daylight Time	08/03/2015 01:30:30 PM Eastern Daylight Time	08/03/2015 03:47:10 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H1112	027	0	2016	Select Counties in GA		2	15499	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-7730		(866)334-7730		(866)527-0056		(866)527-0056		(866)334-7730		(866)334-7730		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1112	032	0	1	02	01	H1112_032_0	6		1	08/01/2015	2016.01	08/01/2015 09:37:21 AM Eastern Daylight Time	08/03/2015 01:31:17 PM Eastern Daylight Time	08/03/2015 03:47:37 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	01	02		1			H1112	032	0	2016	Select Counties in GA		2	3670	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-7730		(866)334-7730		(866)527-0056		(866)527-0056		(866)334-7730		(866)334-7730		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1170	002	0	1	01	01	H1170_002_0	6		1	08/07/2015	2016.01	08/07/2015 09:32:14 PM Eastern Daylight Time	08/07/2015 06:39:41 PM Eastern Daylight Time	08/04/2015 02:17:53 PM Eastern Daylight Time			08/10/2015 04:03:32 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	01	01		1			H1170	002	0	2016	Atlanta Metro Area		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	008	0	1	01	01	H1170_008_0	8	2	1	08/07/2015	2016.01	08/07/2015 09:41:07 PM Eastern Daylight Time	08/07/2015 07:13:03 PM Eastern Daylight Time	08/04/2015 04:03:23 PM Eastern Daylight Time			08/10/2015 04:03:32 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid Plan (HMO SNP)	01	01		1			H1170	008	0	2016	Atlanta Metro Area		2		2			1	3		1	4			kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	009	0	1	01	01	H1170_009_0	5		1	08/07/2015	2016.01	08/07/2015 09:41:49 PM Eastern Daylight Time	08/07/2015 09:08:22 PM Eastern Daylight Time	08/04/2015 02:22:11 PM Eastern Daylight Time			08/10/2015 04:03:32 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H1170	009	0	2016	Atlanta Metro Area		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	801	0	1	01	01	H1170_801_0	1		1	05/19/2015	2016.01	05/19/2015 09:16:31 AM Eastern Daylight Time	05/29/2015 10:32:24 PM Eastern Daylight Time				05/30/2015 02:36:58 AM 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	2016	Atlanta Metro Area		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;16b;	1	7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;16b;	1					2	2			
H1170	802	0	1	01	01	H1170_802_0	1		1	05/19/2015	2016.01	05/19/2015 09:15:35 AM Eastern Daylight Time	05/29/2015 10:42:01 PM Eastern Daylight Time				05/30/2015 02:36:58 AM 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	2016	Atlanta Metro Area		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;16b;	1	7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;16b;	1					2	2			
H1170	805	0	1	01	01	H1170_805_0	1		1	05/19/2015	2016.01	05/19/2015 09:16:56 AM Eastern Daylight Time	05/29/2015 10:53:05 PM Eastern Daylight Time				05/30/2015 02:36:58 AM 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	2016	Atlanta Metro Area		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;16b;	1	7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;16b;	1					2	2			
H1181	001	0	1	07	02	H1181_001_0	7		2	07/23/2015	2016.01	07/23/2015 01:43:05 PM Central Daylight Time			06/01/2015 03:53:59 PM Central Daylight Time		07/23/2015 01:46:54 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	NetworkPrime (MSA)	02	07	2	1			H1181	001	0	2016	Wisconsin		2	2296	2			2										(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529																								
H1189	001	0	1	01	01	H1189_001_0	6		1	08/04/2015	2016.01	08/04/2015 11:57:55 AM US Mountain Standard Time	08/04/2015 04:40:08 PM US Mountain Standard Time	08/04/2015 04:41:31 PM US Mountain Standard Time			08/04/2015 05:09:45 PM US Mountain Standard Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	http://www.christushealthplan.org	CHRISTUS Health Plan Generations (HMO)	01	01		1			H1189	001	0	2016	Santa Fe, San Miguel, Los Alamos		2	800	2			2								http://www.christushealthplan.org/nm2016medicareadvantageformulary	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		(800)659-8331		(800)659-8331		(800)659-8331		(800)659-8331		(800)659-8331		(800)659-8331		(800)659-8331		(800)659-8331		2					2					2	2			
H1230	001	0	1	01	01	H1230_001_0	6		1	07/15/2015	2016.01	07/15/2015 10:58:09 AM Hawaiian Standard Time	07/31/2015 04:55:06 AM Hawaiian Standard Time	07/31/2015 04:58:55 AM Hawaiian Standard Time			08/05/2015 07:19:17 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	01	01		1			H1230	001	0	2016	Islands of Oahu and Maui		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	07/10/2015	2016.01	07/10/2015 12:14:20 PM Hawaiian Standard Time	07/31/2015 04:55:29 AM Hawaiian Standard Time	07/31/2015 04:59:41 AM Hawaiian Standard Time			08/05/2015 07:19:17 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H1230	003	0	2016	Islands of Oahu and Maui		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	005	0	1	01	01	H1230_005_0	6		1	07/10/2015	2016.01	07/10/2015 12:21:31 PM Hawaiian Standard Time	07/31/2015 04:55:50 AM Hawaiian Standard Time	07/31/2015 05:00:25 AM Hawaiian Standard Time			08/05/2015 07:19:17 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Essential (HMO)	01	01		1			H1230	005	0	2016	Island of Hawaii except for 3 ZIPs		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	006	0	1	01	01	H1230_006_0	6		1	07/15/2015	2016.01	07/15/2015 10:58:33 AM Hawaiian Standard Time	07/31/2015 04:56:12 AM Hawaiian Standard Time	07/31/2015 05:04:14 AM Hawaiian Standard Time			08/05/2015 07:19:17 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Essential Plus (HMO)	01	01		1			H1230	006	0	2016	Island of Hawaii except for 3 ZIPs		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	2	1	06/30/2015	2016.01	06/30/2015 08:57:13 AM Hawaiian Standard Time	07/31/2015 04:58:15 AM Hawaiian Standard Time	07/31/2015 05:06:37 AM Hawaiian Standard Time			08/05/2015 07:19:17 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid (HMO SNP)	01	01		1			H1230	008	0	2016	Islands of Oahu and Maui		2		2			1	3		1	3		2	kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	3		1	05/07/2015	2016.01	05/07/2015 08:05:03 AM Hawaiian Standard Time	06/01/2015 09:00:22 AM Hawaiian Standard Time				06/01/2015 09:34:36 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group MA only (HMO)	01	01		1			H1230	801	0	2016	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;6;7b;7g;9b;9d;11a;11b;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;18a;	1					2	2			
H1230	803	0	1	01	01	H1230_803_0	3		1	05/06/2015	2016.01	05/06/2015 07:49:43 AM Hawaiian Standard Time	06/01/2015 09:00:43 AM Hawaiian Standard Time				06/01/2015 09:34:36 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group MA-PD (HMO)	01	01		1			H1230	803	0	2016	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;6;7b;7g;9b;9d;11a;11b;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;18a;	1					2	2			
H1230	804	0	2	01	01	H1230_804_0	4		1	05/06/2015	2016.01	05/06/2015 07:57:48 AM Hawaiian Standard Time	06/01/2015 09:01:05 AM Hawaiian Standard Time				06/01/2015 09:34:36 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group MA-PD Part B (HMO)	01	01		2	1		H1230	804	0	2016	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;6;7b;7g;9b;9d;11a;11b;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;18a;	1					2	2			
H1230	805	0	1	01	01	H1230_805_0	3		1	05/06/2015	2016.01	05/06/2015 08:02:30 AM Hawaiian Standard Time	06/01/2015 09:01:25 AM Hawaiian Standard Time				06/01/2015 09:34:36 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H1230	805	0	2016	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;6;7b;7g;9b;9d;11a;11b;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;18a;	1					2	2			
H1230	806	0	2	01	01	H1230_806_0	4		1	05/06/2015	2016.01	05/06/2015 08:08:01 AM Hawaiian Standard Time	06/01/2015 09:01:48 AM Hawaiian Standard Time				06/01/2015 09:34:36 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB B only with D (HMO)	01	01		2	1		H1230	806	0	2016	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;6;7b;7g;9b;9d;11a;11b;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;14a;16b;18a;	1					2	2			
H1234	001	0	1	20	08	H1234_001_0	1		1	05/20/2015	2016.01	05/20/2015 01:02:32 PM Eastern Daylight Time		05/19/2015 09:11:39 AM Eastern Daylight Time			05/20/2015 01:05:38 PM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Dual (PACE)	08	20		1			H1234	001	0	2016	Mercer County and portions of Burlington County		2		2			2								www.stfrancismedical.org	www.pharmastarpbm.com									(609)599-5474		(609)599-5474		(609)599-5474		(609)599-5474										(609)599-5474		(609)599-5474		(609)599-5474		(609)599-5474																
H1234	002	0	1	20	08	H1234_002_0	1		1	05/20/2015	2016.01	05/20/2015 01:03:29 PM Eastern Daylight Time		05/19/2015 09:12:25 AM Eastern Daylight Time			05/20/2015 01:05:38 PM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Medicare only (PACE)	08	20		1			H1234	002	0	2016	Mercer County and portions of Burlington County		2		2			2								www.stfrancismedical.org	www.pharmastarpbm.com									(609)599-5474		(609)599-5474		(609)599-5474		(609)599-5474										(609)599-5474		(609)599-5474		(609)599-5474		(609)599-5474																
H1239	001	0	1	20	08	H1239_001_0	1		1	05/21/2015	2016.01	05/21/2015 02:44:53 PM Eastern Daylight Time		05/21/2015 02:33:58 PM Eastern Daylight Time			05/21/2015 02:47:59 PM Eastern Daylight Time	KISSITO PACE OF ROANOKE, INC.	Kissito PACE Marketing	www.kissitopace.org	Kissito PACE Part D (PACE)	08	20		1			H1239	001	0	2016	Kissito PACE of Roanoke, INC.		2		2			2								www.kissito.org	www.seniorscript.com									(540)904-2817	113	(540)904-2817	113	(540)904-2817	113	(540)904-2817	113									(540)904-2817	113	(540)904-2817	113	(540)904-2817	113	(540)904-2817	113															
H1239	002	0	1	20	08	H1239_002_0	1		1	05/21/2015	2016.01	05/21/2015 02:45:45 PM Eastern Daylight Time		05/21/2015 02:34:02 PM Eastern Daylight Time			05/21/2015 02:47:59 PM Eastern Daylight Time	KISSITO PACE OF ROANOKE, INC.	Kissito PACE Marketing	www.KissitoPACE.org	Kissito PACE (PACE)	08	20		1			H1239	002	0	2016	Kissito PACE of Roanoke INC.		2		2			2								www.kissito.org	www.seniorscript.com									(540)904-2817	113	(540)904-2817	113	(540)904-2817	113	(540)904-2817	113									(540)904-2817	113	(540)904-2817	113	(540)904-2817	113	(540)904-2817	113															
H1264	004	0	1	02	01	H1264_004_0	4		1	08/01/2015	2016.01	08/01/2015 09:23:23 AM Eastern Daylight Time	08/03/2015 01:32:06 PM Eastern Daylight Time	08/03/2015 03:48:05 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H1264	004	0	2016	Select Counties in TX		2	8005	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8878		(866)687-8878		(866)527-0056		(866)527-0056		(866)687-8878		(866)687-8878		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1264	007	0	1	01	01	H1264_007_0	3	2	1	07/10/2015	2016.01	07/10/2015 12:57:45 PM Eastern Daylight Time	08/03/2015 01:32:58 PM Eastern Daylight Time	08/03/2015 03:48:32 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1264	007	0	2016	Select Counties in TX		2	10268	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9495		(866)530-9495		(866)527-0056		(866)527-0056		(866)530-9495		(866)530-9495		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1264	008	0	1	01	01	H1264_008_0	4		1	08/01/2015	2016.01	08/01/2015 09:23:45 AM Eastern Daylight Time	08/03/2015 01:33:50 PM Eastern Daylight Time	08/03/2015 03:48:59 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	01	01		1			H1264	008	0	2016	Select Counties in TX		2	14989	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8878		(866)687-8878		(866)527-0056		(866)527-0056		(866)687-8878		(866)687-8878		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1264	018	0	1	01	01	H1264_018_0	3	2	1	07/10/2015	2016.01	07/10/2015 12:58:08 PM Eastern Daylight Time	08/03/2015 01:34:40 PM Eastern Daylight Time	08/03/2015 03:49:27 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1264	018	0	2016	El Paso County		2	1407	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9495		(866)530-9495		(866)527-0056		(866)527-0056		(866)530-9495		(866)530-9495		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1264	019	0	1	02	01	H1264_019_0	4		1	08/01/2015	2016.01	08/01/2015 09:24:05 AM Eastern Daylight Time	08/03/2015 01:35:32 PM Eastern Daylight Time	08/03/2015 03:49:54 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	01	02		1			H1264	019	0	2016	Bexar, Harris Counties		2		2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)687-8878		(866)687-8878		(866)527-0056		(866)527-0056		(866)687-8878		(866)687-8878		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1286	002	0	1	01	01	H1286_002_0	3		1	08/03/2015	2016.01	08/03/2015 05:04:36 PM Central Daylight Time	07/31/2015 02:06:46 PM Central Daylight Time	07/30/2015 07:44:53 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1286	002	0	2016	Spokane County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1286	003	0	1	01	01	H1286_003_0	3		1	06/01/2015	2016.01	06/01/2015 11:26:01 AM Central Daylight Time	05/29/2015 03:00:44 PM Central Daylight Time				07/13/2015 01:40:50 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H1286	003	0	2016	Spokane County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1286	009	0	1	01	01	H1286_009_0	3		1	07/31/2015	2016.01	07/31/2015 12:43:19 PM Central Daylight Time	07/31/2015 02:07:11 PM Central Daylight Time	07/30/2015 07:45:36 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1286	009	0	2016	Spokane County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1291	001	0	1	09	04	H1291_001_0	3		1	07/08/2015	2016.01	07/08/2015 02:14:41 PM Eastern Daylight Time	08/03/2015 03:04:41 PM Eastern Daylight Time	07/29/2015 09:42:42 PM Eastern Daylight Time			08/04/2015 01:08:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Gold Choice H1291-001 (PFFS)	04	09	1	1			H1291	001	0	2016	Select Counties in New York		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1302	004	0	1	04	01	H1302_004_0	2		1	06/30/2015	2016.01	06/30/2015 11:49:39 AM Mountain Daylight Time	05/30/2015 07:40:17 AM Mountain Daylight Time				07/06/2015 03:49:47 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue (PPO)	01	04		1			H1302	004	0	2016	Select Counties in Idaho		2	788	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										2					2						2			
H1302	007	1	1	04	01	H1302_007_1	5		1	07/02/2015	2016.01	07/02/2015 04:56:19 PM Mountain Daylight Time	08/04/2015 10:49:25 AM Mountain Daylight Time	08/04/2015 10:49:28 AM Mountain Daylight Time			08/05/2015 08:45:41 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue Idaho (PPO)	01	04		1			H1302	007	1	2016	Select Counties Idaho	Select Counties 1 Idaho	2	2066	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2						2			
H1302	007	2	1	04	01	H1302_007_2	5		1	06/29/2015	2016.01	06/29/2015 04:28:01 PM Mountain Daylight Time	08/04/2015 10:49:34 AM Mountain Daylight Time	08/04/2015 10:49:39 AM Mountain Daylight Time			08/05/2015 08:45:41 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue Idaho (PPO)	01	04		1			H1302	007	2	2016	Select Counties Idaho	Select Counties 2 Idaho	2	2427	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2						2			
H1304	001	0	1	04	01	H1304_001_0	5		1	06/30/2015	2016.01	06/30/2015 11:00:28 AM Mountain Daylight Time	07/07/2015 11:53:38 AM Mountain Daylight Time				07/07/2015 03:27:15 PM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H1304	001	0	2016	Select Counties in Idaho/Asotin Co, WA		2	305	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1304	002	0	1	04	01	H1304_002_0	7		1	06/30/2015	2016.01	06/30/2015 11:00:39 AM Mountain Daylight Time	08/04/2015 02:44:10 PM Mountain Daylight Time	08/05/2015 04:22:54 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H1304	002	0	2016	Select Counties in Idaho/Asotin Co, WA		2	2486	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1304	004	0	1	04	01	H1304_004_0	6		1	06/30/2015	2016.01	06/30/2015 11:00:49 AM Mountain Daylight Time	08/04/2015 02:41:32 PM Mountain Daylight Time	08/05/2015 04:23:13 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H1304	004	0	2016	Select Counties in Idaho/Asotin Co, WA		2	867	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1304	008	0	1	04	01	H1304_008_0	5		1	06/30/2015	2016.01	06/30/2015 11:01:02 AM Mountain Daylight Time	07/07/2015 11:54:02 AM Mountain Daylight Time				07/07/2015 03:27:15 PM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H1304	008	0	2016	Ada, Boise, Canyon, Gem, and Owyhee counties		2	30	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H1304	009	0	1	04	01	H1304_009_0	7		1	06/30/2015	2016.01	06/30/2015 11:01:14 AM Mountain Daylight Time	08/04/2015 02:42:46 PM Mountain Daylight Time	08/05/2015 04:23:31 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H1304	009	0	2016	Ada, Boise, Canyon, Gem, and Owyhee counties		2	2277	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1304	010	0	1	04	01	H1304_010_0	7		1	06/30/2015	2016.01	06/30/2015 11:01:27 AM Mountain Daylight Time	08/04/2015 02:43:18 PM Mountain Daylight Time	08/05/2015 04:23:48 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H1304	010	0	2016	Ada, Boise, Canyon, Gem, and Owyhee counties		2	237	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1304	803	0	1	04	01	H1304_803_0	6		1	06/30/2015	2016.01	06/30/2015 12:03:40 PM Mountain Daylight Time	08/04/2015 02:44:54 PM Mountain Daylight Time				08/06/2015 11:27:01 AM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H1304	803	0	2016	Nationwide except territories		1	1000	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;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;12;15;	2		1						2			
H1304	804	0	1	04	01	H1304_804_0	7		1	06/09/2015	2016.01	06/09/2015 10:02:12 AM Mountain Daylight Time	08/04/2015 02:41:04 PM Mountain Daylight Time				08/06/2015 11:27:01 AM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H1304	804	0	2016	Nationwide except territories		1	1000	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;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;12;15;	2		1						2			
H1310	001	0	1	20	08	H1310_001_0	1		1	05/27/2015	2016.01	05/27/2015 09:04:37 AM Eastern Daylight Time		05/26/2015 03:11:05 PM Eastern Daylight Time			05/27/2015 09:06:22 AM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	CentraCare	www.mycentracare.com	CentraCare Dual (PACE)	08	20		1			H1310	001	0	2016	Calhoun, Kalamazoo, and VanBuren Counties		2		2			2								mycentracare.com	mycentracare.com									(877)284-4071		(269)441-9332		(877)284-4071		(269)441-9300										(800)649-3777		(269)441-9329		(800)649-3777		(269)441-9329																
H1310	003	0	1	20	08	H1310_003_0	1		1	05/27/2015	2016.01	05/27/2015 09:05:11 AM Eastern Daylight Time		05/26/2015 03:12:20 PM Eastern Daylight Time			05/27/2015 09:06:22 AM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	CentraCare	www.mycentracare.com	CentraCare Medicare-only (PACE)	08	20		1			H1310	003	0	2016	Calhoun, Kalamazoo, and VanBuren Counties		2		2			2								mycentracare.com	mycentracare.com									(877)284-4071		(269)441-9332		(877)284-4071		(269)441-9300										(800)649-3777		(269)441-9329		(800)649-3777		(269)441-9329																
H1350	006	0	1	01	01	H1350_006_0	2		1	06/29/2015	2016.01	06/29/2015 04:33:52 PM Mountain Daylight Time	05/30/2015 07:41:52 AM Mountain Daylight Time				07/06/2015 03:49:47 PM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue (HMO)	01	01		1			H1350	006	0	2016	Select Counties in Idaho		2	3504	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										2					2					2	2			
H1350	009	0	1	01	01	H1350_009_0	5	2	1	06/29/2015	2016.01	06/29/2015 04:42:06 PM Mountain Daylight Time	08/04/2015 10:49:48 AM Mountain Daylight Time	08/04/2015 10:49:52 AM Mountain Daylight Time			08/05/2015 08:45:41 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Special Needs Plan (HMO SNP)	01	01		1			H1350	009	0	2016	Select Counties in Idaho		2	3264	2			1	3		1	5			www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)495-2583		(208)395-8200		(888)495-2583		(208)387-6673		(888)495-2583		(208)395-8200		(888)495-2583		(208)387-6673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	012	0	1	01	01	H1350_012_0	3		1	06/29/2015	2016.01	06/29/2015 04:44:55 PM Mountain Daylight Time	08/04/2015 10:49:58 AM Mountain Daylight Time	08/04/2015 10:50:02 AM Mountain Daylight Time			08/05/2015 08:45:41 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Connected Care (HMO)	01	01		1			H1350	012	0	2016	Ada, Canyon, Gem, Payette		2	2750	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	014	0	1	01	01	H1350_014_0	5		1	06/29/2015	2016.01	06/29/2015 04:50:54 PM Mountain Daylight Time	08/04/2015 10:50:09 AM Mountain Daylight Time	08/04/2015 10:50:12 AM Mountain Daylight Time			08/05/2015 08:45:41 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Freedom II (HMO)	01	01		1			H1350	014	0	2016	Select Counties Idaho		2	2250	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	015	1	1	02	01	H1350_015_1	5		1	06/29/2015	2016.01	06/29/2015 04:53:08 PM Mountain Daylight Time	08/04/2015 10:50:17 AM Mountain Daylight Time	08/04/2015 10:50:19 AM Mountain Daylight Time			08/05/2015 08:45:41 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Rx Option I (HMO-POS)	01	02		1			H1350	015	1	2016	Select Counties Idaho	Select Counties 1 Idaho	2	7945	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	015	2	1	02	01	H1350_015_2	5		1	06/29/2015	2016.01	06/29/2015 04:54:44 PM Mountain Daylight Time	08/04/2015 10:50:25 AM Mountain Daylight Time	08/04/2015 10:50:28 AM Mountain Daylight Time			08/05/2015 08:45:41 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Rx Option I (HMO-POS)	01	02		1			H1350	015	2	2016	Select Counties Idaho	Select Counties 2 Idaho	2	897	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	016	1	1	01	01	H1350_016_1	6		1	06/29/2015	2016.01	06/29/2015 04:57:40 PM Mountain Daylight Time	08/04/2015 10:50:33 AM Mountain Daylight Time	08/04/2015 10:50:35 AM Mountain Daylight Time			08/05/2015 08:45:41 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Rx Option II (HMO)	01	01		1			H1350	016	1	2016	Select Counties Idaho	Select Counties 1 Idaho	2	6948	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	016	2	1	01	01	H1350_016_2	6		1	06/29/2015	2016.01	06/29/2015 04:59:22 PM Mountain Daylight Time	08/04/2015 10:50:41 AM Mountain Daylight Time	08/04/2015 10:50:45 AM Mountain Daylight Time			08/05/2015 08:45:41 AM Mountain Daylight Time	BLUE CROSS OF IDAHO CARE PLUS, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Rx Option II (HMO)	01	01		1			H1350	016	2	2016	Select Counties Idaho	Select Counties 2 Idaho	2	6948	2			2							www.bcidaho.com/FindAProvider	www.bcidaho.com/DrugList	www.bcidaho.com/FindAPharmacy	(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(888)494-2583		(208)395-8200		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2	2			
H1352	001	0	1	01	01	H1352_001_0	4		1	08/04/2015	2016.01	08/04/2015 09:06:05 AM Central Daylight Time	08/04/2015 09:09:27 AM Central Daylight Time	08/04/2015 09:09:26 AM Central Daylight Time			08/04/2015 09:23:07 AM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Complete (HMO)	01	01		1			H1352	001	0	2016	Kansas City Area		2	1668	2			2								www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(800)566-8443		(816)395-3152		(866)508-7140		(866)508-7140		(800)566-8443		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1352	002	0	1	01	01	H1352_002_0	5		1	08/04/2015	2016.01	08/04/2015 09:06:14 AM Central Daylight Time	08/04/2015 09:09:26 AM Central Daylight Time	08/04/2015 09:09:26 AM Central Daylight Time			08/04/2015 09:23:07 AM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Plus (HMO)	01	01		1			H1352	002	0	2016	Kansas City Area		2	4832	2			2								www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(800)566-8443		(816)395-3152		(866)508-7140		(866)508-7140		(800)566-8443		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1352	801	0	1	01	01	H1352_801_0	1		1	05/28/2015	2016.01	05/28/2015 05:43:01 PM Central Daylight Time	05/29/2015 02:45:28 PM Central Daylight Time				05/29/2015 02:54:49 PM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Employer Group Plan MA-CY (HMO)	01	01		1			H1352	801	0	2016	Kansas City Area		1	2000	2			2								www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(800)566-8443		(816)395-3152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;15;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;16b;	1					1	2			
H1352	803	0	1	01	01	H1352_803_0	1		1	05/28/2015	2016.01	05/28/2015 05:44:08 PM Central Daylight Time	05/29/2015 02:45:28 PM Central Daylight Time				05/29/2015 02:54:49 PM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Employer Group Plan MAPDCY (HMO)	01	01		1			H1352	803	0	2016	Kansas City Area		1	50	2			2								www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(800)566-8443		(816)395-3152		(866)508-7140		(866)508-7140		(800)566-8443		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;15;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;16b;	1					1	2			
H1352	804	0	1	01	01	H1352_804_0	1		1	05/28/2015	2016.01	05/28/2015 05:45:12 PM Central Daylight Time	05/29/2015 02:45:28 PM Central Daylight Time				05/29/2015 02:54:49 PM Central Daylight Time	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Employer Group Plan MAPDBY (HMO)	01	01		1			H1352	804	0	2016	Kansas City Area		1	50	2			2								www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(800)566-8443		(816)395-3152		(866)508-7140		(866)508-7140		(800)566-8443		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;15;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;16b;	1					1	2			
H1357	001	0	1	20	08	H1357_001_0	1		1	05/21/2015	2016.01	05/21/2015 01:59:21 PM Eastern Daylight Time		05/18/2015 10:21:02 AM Eastern Daylight Time			05/21/2015 03:58:30 PM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	08	20		1			H1357	001	0	2016	Carolina SeniorCare		2		2			2								www.uchas.org	www.uchas.org									(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500										(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500																
H1357	002	0	1	20	08	H1357_002_0	1		1	05/21/2015	2016.01	05/21/2015 02:00:19 PM Eastern Daylight Time		05/18/2015 10:18:04 AM Eastern Daylight Time			05/21/2015 03:58:30 PM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	www.uchas.org	Carolina SeniorCare (PACE)	08	20		1			H1357	002	0	2016	Carolina SeniorCare		2		2			2								www.uchas.org	www.uchas.org									(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500										(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500																
H1365	001	0	1	04	01	H1365_001_0	10		1	08/04/2015	2016.01	08/04/2015 02:04:18 PM Eastern Daylight Time	08/04/2015 01:56:51 PM Eastern Daylight Time	08/04/2015 01:56:51 PM Eastern Daylight Time			08/04/2015 02:52:58 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	001	0	2016	Counties: Andr,Cumb,Frk,Knx,Linc,Oxf, Sag,Wald,Yrk		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	002	0	1	04	01	H1365_002_0	10		1	08/07/2015	2016.01	08/07/2015 09:17:35 AM Eastern Daylight Time	08/07/2015 01:26:26 PM Eastern Daylight Time	08/04/2015 01:56:51 PM Eastern Daylight Time			08/07/2015 01:29:15 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	002	0	2016	Counties: Aroos, Hanc,Kenn,Penob,Pisc, Som,Wash		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	003	0	1	04	01	H1365_003_0	12		1	07/30/2015	2016.01	07/30/2015 07:44:07 PM Eastern Daylight Time	08/04/2015 01:56:52 PM Eastern Daylight Time	08/04/2015 01:56:52 PM Eastern Daylight Time			08/04/2015 02:52:58 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	003	0	2016	Hillsborough, Strafford, NH		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	802	0	1	04	01	H1365_802_0	7		1	07/13/2015	2016.01	07/13/2015 08:56:20 AM Eastern Daylight Time	07/17/2015 02:23:25 PM Eastern Daylight Time				07/20/2015 03:42:15 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Premier Group (PPO)	01	04		1			H1365	802	0	2016	National		1		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(888)423-9320		(888)423-9320		(888)640-4423		(888)640-4423		(888)423-9320		(888)423-9320		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1365	803	0	1	04	01	H1365_803_0	7		1	07/13/2015	2016.01	07/13/2015 08:56:49 AM Eastern Daylight Time	07/17/2015 02:23:25 PM Eastern Daylight Time				07/20/2015 03:42:15 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Premier Group (PPO)	01	04		1			H1365	803	0	2016	National		1		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1394	003	0	1	01	01	H1394_003_0	9		1	08/01/2015	2016.01	08/01/2015 03:47:48 AM Pacific Daylight Time	08/01/2015 06:17:11 PM Pacific Daylight Time	07/30/2015 03:32:10 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H1394	003	0	2016	Denver and Douglas		2	383	2			2							www.anthem.com/medicare	https://www.anthem.com/health-insurance/	https://www.anthem.com/health-insurance/	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1394	006	0	1	01	01	H1394_006_0	8	2	1	08/05/2015	2016.01	08/05/2015 11:43:33 AM Pacific Daylight Time	08/04/2015 07:31:44 AM Pacific Daylight Time	07/30/2015 04:43:16 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H1394	006	0	2016	Denver and Douglas		2	120	2			1	3		1	5			www.anthem.com/medicare	https://www.anthem.com/health-insurance/	https://www.anthem.com/health-insurance/	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1394	801	0	1	01	01	H1394_801_0	5		1	05/27/2015	2016.01	05/27/2015 02:38:15 PM Pacific Daylight Time	05/31/2015 03:03:19 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	HMO COLORADO, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H1394	801	0	2016	Colorado		1	50	2			2							www.anthem.com/medicare	https://www.anthem.com/health-insurance/	https://www.anthem.com/health-insurance/	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H1406	013	0	1	01	01	H1406_013_0	3		1	07/07/2015	2016.01	07/07/2015 04:00:48 PM Eastern Daylight Time	08/04/2015 10:29:38 AM Eastern Daylight Time	07/30/2015 11:22:24 AM Eastern Daylight Time			08/04/2015 01:08:09 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-013 (HMO)	01	01		1			H1406	013	0	2016	Cook, Lake and Will counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1406	022	0	1	01	01	H1406_022_0	3		1	07/08/2015	2016.01	07/08/2015 02:20:46 PM Eastern Daylight Time	08/04/2015 11:51:15 AM Eastern Daylight Time	07/30/2015 11:23:00 AM Eastern Daylight Time			08/04/2015 01:08:09 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-022 (HMO)	01	01		1			H1406	022	0	2016	Kane, Kendall and McHenry counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1406	026	0	1	01	01	H1406_026_0	5		1	07/08/2015	2016.01	07/08/2015 02:23:56 PM Eastern Daylight Time	08/04/2015 03:59:01 PM Eastern Daylight Time	07/30/2015 11:23:36 AM Eastern Daylight Time			08/05/2015 08:44:41 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-026 (HMO)	01	01		1			H1406	026	0	2016	Rockford Illinois area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1406	028	0	1	01	01	H1406_028_0	3		1	07/08/2015	2016.01	07/08/2015 02:26:11 PM Eastern Daylight Time	08/04/2015 12:12:47 PM Eastern Daylight Time	07/30/2015 11:24:14 AM Eastern Daylight Time			08/04/2015 01:08:09 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-028 (HMO)	01	01		1			H1406	028	0	2016	DuPage County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1406	029	0	1	01	01	H1406_029_0	4		1	07/14/2015	2016.01	07/14/2015 03:04:48 PM Eastern Daylight Time	08/04/2015 12:11:32 PM Eastern Daylight Time	07/30/2015 11:24:50 AM Eastern Daylight Time			08/04/2015 01:08:09 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H1406	029	0	2016	DuPage County		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1406	030	0	1	01	01	H1406_030_0	3		1	07/08/2015	2016.01	07/08/2015 02:31:31 PM Eastern Daylight Time	08/04/2015 12:06:27 PM Eastern Daylight Time	07/29/2015 09:46:14 PM Eastern Daylight Time			08/04/2015 01:08:09 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-030 (HMO)	01	01		1			H1406	030	0	2016	Logan and Sangamon counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1406	032	0	1	01	01	H1406_032_0	4		1	07/14/2015	2016.01	07/14/2015 02:34:14 PM Eastern Daylight Time	08/04/2015 11:52:30 AM Eastern Daylight Time	07/29/2015 09:46:50 PM Eastern Daylight Time			08/04/2015 01:18:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Community HMO Diabetes and Heart (HMO SNP)	01	01		1			H1406	032	0	2016	Cook County		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1406	801	0	1	01	01	H1406_801_0	1		1	05/11/2015	2016.01	05/11/2015 02:01:35 PM Eastern Daylight Time	05/29/2015 08:11:36 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1406	801	0	2016	Select counties in Chicago Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1406	802	0	1	01	01	H1406_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:02:31 PM Eastern Daylight Time	05/29/2015 08:15:32 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1406	802	0	2016	Select counties in Chicago Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1415	005	0	1	01	01	H1415_005_0	5	2	1	07/14/2015	2016.01	07/14/2015 04:05:25 PM Central Daylight Time	08/01/2015 09:38:29 AM Central Daylight Time	07/30/2015 08:10:28 AM Central Daylight Time			08/03/2015 09:09:24 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H1415	005	0	2016	Cook, DuPage, Kane,  and Will		2		2			1	3		1	2				www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1415	013	0	1	01	01	H1415_013_0	4		1	07/09/2015	2016.01	07/09/2015 04:41:04 PM Central Daylight Time	07/12/2015 09:18:16 AM Central Daylight Time				07/16/2015 01:03:39 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H1415	013	0	2016	Cook, DuPage, Kane, and Will		2		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1415	021	0	1	02	01	H1415_021_0	4		1	07/14/2015	2016.01	07/14/2015 04:08:25 PM Central Daylight Time	08/01/2015 09:38:59 AM Central Daylight Time	07/30/2015 08:10:58 AM Central Daylight Time			08/03/2015 09:09:24 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H1415	021	0	2016	Cook, DuPage, Kane, and Will		2		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1415	024	0	1	01	01	H1415_024_0	5		1	07/14/2015	2016.01	07/14/2015 04:08:21 PM Central Daylight Time	08/01/2015 09:39:35 AM Central Daylight Time	07/30/2015 08:11:34 AM Central Daylight Time			08/03/2015 09:09:24 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	01	01		1			H1415	024	0	2016	Cook, DuPage, Kane, and Will		2		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	007	0	1	01	01	H1416_007_0	4	2	1	07/10/2015	2016.01	07/10/2015 12:58:42 PM Eastern Daylight Time	08/03/2015 01:36:21 PM Eastern Daylight Time	08/03/2015 03:50:21 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	HARMONY HEALTH PLAN OF ILLINOIS, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1416	007	0	2016	Select Counties in IL		2	5129	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)439-1190		(866)439-1190		(866)527-0056		(866)527-0056		(866)439-1190		(866)439-1190		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1416	009	0	1	02	01	H1416_009_0	4		1	08/01/2015	2016.01	08/01/2015 09:24:27 AM Eastern Daylight Time	08/03/2015 01:37:10 PM Eastern Daylight Time	08/03/2015 03:50:49 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	HARMONY HEALTH PLAN OF ILLINOIS, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H1416	009	0	2016	Select Counties in IL		2	10303	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(866)334-6876		(866)334-6876		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1416	023	0	1	01	01	H1416_023_0	4		1	07/10/2015	2016.01	07/10/2015 12:59:11 PM Eastern Daylight Time	08/03/2015 01:38:02 PM Eastern Daylight Time	08/03/2015 03:51:16 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	HARMONY HEALTH PLAN OF ILLINOIS, INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H1416	023	0	2016	Select Counties in IL		2	401	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(866)334-6876		(866)334-6876		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1416	024	0	1	02	01	H1416_024_0	4		1	08/01/2015	2016.01	08/01/2015 09:24:44 AM Eastern Daylight Time	08/03/2015 01:38:52 PM Eastern Daylight Time	08/03/2015 03:51:43 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	HARMONY HEALTH PLAN OF ILLINOIS, INC.	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO-POS)	01	02		1			H1416	024	0	2016	Select Counties in IL		2		2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)334-6876		(866)334-6876		(866)527-0056		(866)527-0056		(866)439-1190		(866)439-1190		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1417	001	0	1	04	01	H1417_001_0	3		1	07/01/2015	2016.01	07/01/2015 07:31:18 AM Central Daylight Time	05/30/2015 03:54:44 PM Central Daylight Time				07/02/2015 12:44:23 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO10 (PPO)	01	04		1			H1417	001	0	2016	Central Illinois		2	299	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2						2			
H1417	002	0	1	04	01	H1417_002_0	4		1	07/01/2015	2016.01	07/01/2015 07:34:15 AM Central Daylight Time	08/03/2015 09:25:11 AM Central Daylight Time	08/02/2015 04:59:34 PM Central Daylight Time			08/04/2015 03:05:33 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO10 Rx (PPO)	01	04		1			H1417	002	0	2016	Central Illinois		2	4388	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2						2			
H1417	003	0	1	04	01	H1417_003_0	3		1	07/01/2015	2016.01	07/01/2015 12:57:14 PM Central Daylight Time	05/30/2015 03:56:11 PM Central Daylight Time				07/02/2015 12:44:23 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO30 (PPO)	01	04		1			H1417	003	0	2016	Central Illinois		2	200	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2						2			
H1417	004	0	1	04	01	H1417_004_0	4		1	07/01/2015	2016.01	07/01/2015 07:40:09 AM Central Daylight Time	08/03/2015 02:40:34 PM Central Daylight Time	08/02/2015 05:00:09 PM Central Daylight Time			08/04/2015 03:05:33 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO30 Rx (PPO)	01	04		1			H1417	004	0	2016	Central Illinois		2	2351	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2						2			
H1417	010	0	1	04	01	H1417_010_0	4		1	07/01/2015	2016.01	07/01/2015 07:42:18 AM Central Daylight Time	08/03/2015 02:41:24 PM Central Daylight Time	08/02/2015 05:00:43 PM Central Daylight Time			08/04/2015 03:05:33 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO Basic Rx (PPO)	01	04		1			H1417	010	0	2016	Central Illinois		2	585	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2						2			
H1417	011	0	1	04	01	H1417_011_0	3		1	07/01/2015	2016.01	07/01/2015 01:21:16 PM Central Daylight Time	05/30/2015 03:58:20 PM Central Daylight Time				07/02/2015 12:44:23 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO Basic (PPO)	01	04		1			H1417	011	0	2016	Central Illinois		2	45	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2						2			
H1417	801	0	1	04	01	H1417_801_0	2		1	05/27/2015	2016.01	05/27/2015 11:25:55 AM Central Daylight Time	05/30/2015 03:59:10 PM Central Daylight Time				05/31/2015 08:11:14 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer PPO (PPO)	01	04		1			H1417	801	0	2016	Illinois		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										1	2		2		1						2			
H1417	802	0	1	04	01	H1417_802_0	2		1	05/14/2015	2016.01	05/14/2015 09:43:02 AM Central Daylight Time	05/30/2015 03:59:58 PM Central Daylight Time				05/31/2015 08:11:14 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer PPO Rx (PPO)	01	04		1			H1417	802	0	2016	Illinois		1	411	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		1	2		2		1						2			
H1417	810	0	1	04	01	H1417_810_0	2		1	05/14/2015	2016.01	05/14/2015 09:43:13 AM Central Daylight Time	05/30/2015 04:00:46 PM Central Daylight Time				05/31/2015 08:11:14 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer PPO Rx (PPO) - non calendar year (PPO)	01	04		1			H1417	810	0	2016	Illinois		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		1	2		2		1						2			
H1418	002	0	1	04	01	H1418_002_0	3		1	07/08/2015	2016.01	07/08/2015 02:53:39 PM Eastern Daylight Time	08/04/2015 10:32:35 AM Eastern Daylight Time	07/29/2015 09:47:26 PM Eastern Daylight Time			08/04/2015 01:08:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1418-002 (PPO)	01	04		1			H1418	002	0	2016	Chicago Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1418	007	0	1	04	01	H1418_007_0	3		1	07/08/2015	2016.01	07/08/2015 02:50:10 PM Eastern Daylight Time	08/04/2015 10:57:05 AM Eastern Daylight Time	07/29/2015 09:48:00 PM Eastern Daylight Time			08/04/2015 01:08:09 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1418-007 (PPO)	01	04		1			H1418	007	0	2016	Central Illinois area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1418	008	0	1	04	01	H1418_008_0	3		1	07/07/2015	2016.01	07/07/2015 03:09:06 PM Eastern Daylight Time	08/04/2015 09:56:04 AM Eastern Daylight Time	07/29/2015 09:48:36 PM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1418-008 (PPO)	01	04		1			H1418	008	0	2016	Scott County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1463	001	0	1	01	01	H1463_001_0	3		1	07/01/2015	2016.01	07/01/2015 07:44:22 AM Central Daylight Time	05/30/2015 04:01:30 PM Central Daylight Time				07/02/2015 12:33:32 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO20 (HMO)	01	01		1			H1463	001	0	2016	East Central Illinois		2	1148	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2					2	2			
H1463	003	0	1	01	01	H1463_003_0	4		1	07/01/2015	2016.01	07/01/2015 07:47:29 AM Central Daylight Time	08/03/2015 09:29:30 AM Central Daylight Time	08/02/2015 05:01:17 PM Central Daylight Time			08/04/2015 03:14:14 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO20 Rx (HMO)	01	01		1			H1463	003	0	2016	East Central Illinois		2	4264	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					2	2			
H1463	008	0	1	01	01	H1463_008_0	3		1	07/01/2015	2016.01	07/01/2015 07:49:40 AM Central Daylight Time	05/30/2015 04:02:57 PM Central Daylight Time				07/02/2015 12:33:32 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO Basic (HMO)	01	01		1			H1463	008	0	2016	East Central Illinois		2	444	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2					2	2			
H1463	009	0	1	01	01	H1463_009_0	4		1	07/01/2015	2016.01	07/01/2015 07:51:43 AM Central Daylight Time	08/03/2015 09:30:58 AM Central Daylight Time	08/02/2015 05:01:52 PM Central Daylight Time			08/04/2015 03:14:14 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO Basic Rx (HMO)	01	01		1			H1463	009	0	2016	East Central Illinois		2	1010	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					2	2			
H1463	010	0	1	01	01	H1463_010_0	4		1	07/01/2015	2016.01	07/01/2015 07:53:42 AM Central Daylight Time	08/03/2015 09:31:42 AM Central Daylight Time	08/02/2015 05:02:26 PM Central Daylight Time			08/04/2015 03:14:14 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO 40 Rx (HMO)	01	01		1			H1463	010	0	2016	East Central Illinois		2	696	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					2	2			
H1463	011	0	1	01	01	H1463_011_0	3		1	07/01/2015	2016.01	07/01/2015 07:55:35 AM Central Daylight Time	05/30/2015 04:05:06 PM Central Daylight Time				07/02/2015 12:33:32 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO 40 (HMO)	01	01		1			H1463	011	0	2016	East Central Illinois		2	19	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2					2	2			
H1463	801	0	1	01	01	H1463_801_0	2		1	05/14/2015	2016.01	05/14/2015 09:45:03 AM Central Daylight Time	05/30/2015 04:05:56 PM Central Daylight Time				05/31/2015 08:21:21 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1463	801	0	2016	Illinois		1	8	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										1	2		2		1					1	2			
H1463	802	0	1	01	01	H1463_802_0	2		1	05/14/2015	2016.01	05/14/2015 09:45:15 AM Central Daylight Time	05/30/2015 04:06:46 PM Central Daylight Time				05/31/2015 08:21:21 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H1463	802	0	2016	Illinois		1	123	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		1	2		2		1					1	2			
H1463	810	0	1	01	01	H1463_810_0	2		1	05/14/2015	2016.01	05/14/2015 09:45:28 AM Central Daylight Time	05/30/2015 04:07:35 PM Central Daylight Time				05/31/2015 08:21:21 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO) - non calendar year (HMO)	01	01		1			H1463	810	0	2016	Illinois		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		1	2		2		1					1	2			
H1468	007	0	1	01	01	H1468_007_0	3		1	07/08/2015	2016.01	07/08/2015 02:54:08 PM Eastern Daylight Time	08/04/2015 11:10:14 AM Eastern Daylight Time	07/30/2015 11:25:26 AM Eastern Daylight Time			08/04/2015 01:08:09 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Gold Plus H1468-007 (HMO)	01	01		1			H1468	007	0	2016	Peoria Illinois Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/11/2015	2016.01	05/11/2015 02:03:29 PM Eastern Daylight Time	05/29/2015 08:19:17 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1468	802	0	2016	Select counties in Peoria Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1468	803	0	1	01	01	H1468_803_0	1		1	05/11/2015	2016.01	05/11/2015 02:04:31 PM Eastern Daylight Time	05/29/2015 08:19:45 AM Eastern Daylight Time				05/29/2015 12:36:28 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1468	803	0	2016	Select counties in Peoria Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1493	001	0	1	01	01	H1493_001_0	6		1	08/05/2015	2016.01	08/05/2015 08:10:05 PM Central Daylight Time	08/05/2015 08:51:12 PM Central Daylight Time	08/05/2015 04:53:58 PM Central Daylight Time			08/05/2015 08:58:17 PM Central Daylight Time	CARESOURCE KENTUCKY CO.	CareSource	CareSource.com	CareSource Advantage (HMO)	01	01		1			H1493	001	0	2016	Kentucky		2	750	2			2							https://memberportal.caresource.com/App/Plans	http://caresource.com/	http://caresource.com/			(000)000-0000				(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		2					2					2	2			
H1493	002	0	1	01	01	H1493_002_0	6		1	07/09/2015	2016.01	07/09/2015 08:43:51 AM Central Daylight Time	08/05/2015 04:53:58 PM Central Daylight Time	08/05/2015 04:53:58 PM Central Daylight Time			08/05/2015 05:06:13 PM Central Daylight Time	CARESOURCE KENTUCKY CO.	CareSource	CareSource.com	CareSource Advantage Plus (HMO)	01	01		1			H1493	002	0	2016	Kentucky		2	750	2			2							https://memberportal.caresource.com/App/Plans	http://caresource.com/	http://caresource.com/			(000)000-0000				(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		2					2					2	2			
H1500	001	0	1	20	08	H1500_001_0	1		1	05/20/2015	2016.01	05/20/2015 03:20:07 PM Eastern Daylight Time		05/20/2015 03:17:17 PM Eastern Daylight Time			05/20/2015 03:44:32 PM Eastern Daylight Time	LIFE ST. JOSEPH OF THE PINES, INC.	LIFE St. Joseph of the Pines	www.sjp.org	LIFE St. Joseph of the Pines (PACE)	08	20		1			H1500	001	0	2016	LIFE St. Joseph of the Pines		2		2			2								www.sjp.org	www.sjp.org									(800)246-1000		(910)429-7204		(800)246-1000		(910)429-7204										(800)246-1000		(910)429-7204		(800)246-1000		(910)429-7204																
H1500	002	0	1	20	08	H1500_002_0	1		1	05/20/2015	2016.01	05/20/2015 03:20:28 PM Eastern Daylight Time		05/20/2015 03:17:17 PM Eastern Daylight Time			05/20/2015 03:44:32 PM Eastern Daylight Time	LIFE ST. JOSEPH OF THE PINES, INC.	LIFE St. Joseph of the Pines	www.sjp.org	LIFE St. Joseph of the Pines (PACE)	08	20		1			H1500	002	0	2016	LIFE St. Joseph of the Pines		2		2			2								www.sjp.org	www.sjp.org									(800)246-1000		(910)429-7204		(800)246-1000		(910)429-7204										(800)246-1000		(910)429-7204		(800)246-1000		(910)429-7204																
H1510	001	0	1	04	01	H1510_001_0	3		1	07/07/2015	2016.01	07/07/2015 04:15:31 PM Eastern Daylight Time	07/31/2015 05:45:53 PM Eastern Daylight Time	07/29/2015 09:49:46 PM Eastern Daylight Time			08/04/2015 02:14:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1510-001 (PPO)	01	04		1			H1510	001	0	2016	Central Indiana Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1510	004	0	1	04	01	H1510_004_0	3		1	07/08/2015	2016.01	07/08/2015 08:29:23 AM Eastern Daylight Time	07/31/2015 05:42:02 PM Eastern Daylight Time	07/29/2015 09:50:22 PM Eastern Daylight Time			08/04/2015 02:14:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1510-004 (PPO)	01	04		1			H1510	004	0	2016	Select counties in Indiana		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1510	005	0	1	04	01	H1510_005_0	3		1	07/08/2015	2016.01	07/08/2015 07:57:27 AM Eastern Daylight Time	07/31/2015 05:42:38 PM Eastern Daylight Time	07/29/2015 09:50:58 PM Eastern Daylight Time			08/04/2015 02:14:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1510-005 (PPO)	01	04		1			H1510	005	0	2016	Northern Indiana Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1517	007	0	1	04	01	H1517_007_0	10		1	07/20/2015	2016.01	07/20/2015 09:45:48 AM Eastern Daylight Time	08/01/2015 09:18:20 PM Eastern Daylight Time	07/30/2015 06:41:15 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H1517	007	0	2016	St Louis Springfield Joplin area		2	3305	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7798		(855)690-7798		(800)797-6427		(800)797-6427		(855)690-7798		(855)690-7798		(844)364-2109		(844)364-2109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1517	801	0	1	04	01	H1517_801_0	4		1	05/29/2015	2016.01	05/29/2015 12:14:21 PM Pacific Daylight Time	05/31/2015 01:15:27 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1517	801	0	2016	Missouri		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H1517	802	0	1	04	01	H1517_802_0	4		1	05/29/2015	2016.01	05/29/2015 12:14:26 PM Pacific Daylight Time	05/31/2015 09:38:23 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1517	802	0	2016	Missouri		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H1517	803	0	1	04	01	H1517_803_0	4		1	05/29/2015	2016.01	05/29/2015 12:14:14 PM Pacific Daylight Time	05/31/2015 01:15:37 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1517	803	0	2016	Missouri		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H1518	001	0	1	20	08	H1518_001_0	1		1	05/20/2015	2016.01	05/20/2015 01:12:31 PM Eastern Daylight Time		05/14/2015 04:28:01 PM Eastern Daylight Time			05/20/2015 01:17:15 PM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	www.chsbuffalo.org/services/seniorservices/LIFE	CHS Buffalo - Dual (PACE)	08	20		1			H1518	001	0	2016	CHS Lackawanna  Erie County		2		2			2								www.chsbuffalo.org	www.chsbuffalo.org									(888)845-0247		(716)819-5433		(888)845-0247		(716)819-5061										(888)845-0247		(716)819-5433		(888)845-0247		(716)819-5061																
H1518	002	0	1	20	08	H1518_002_0	1		1	05/20/2015	2016.01	05/20/2015 01:13:00 PM Eastern Daylight Time		05/14/2015 04:38:58 PM Eastern Daylight Time			05/20/2015 01:17:15 PM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	www.chsbuffalo.org/Services/SeniorServices/LIFE	CHS Buffalo - Medicare only (PACE)	08	20		1			H1518	002	0	2016	CHS Lackawanna Erie County		2		2			2								www.chsbuffalo.org	www.chsbuffalo.org									(888)845-0247		(716)819-5433		(888)845-0247		(716)819-5061										(888)845-0247		(716)819-5433		(888)845-0247		(716)819-5061																
H1533	001	0	1	20	08	H1533_001_0	1		1	05/21/2015	2016.01	05/21/2015 01:21:20 PM Eastern Daylight Time		05/19/2015 05:06:45 PM Eastern Daylight Time			05/21/2015 01:23:35 PM Eastern Daylight Time	STAYWELL SENIOR CARE, INC.	StayWell Senior Care	www.staywellseniorcare.org	StayWell Senior Care - Dual Eligible (PACE)	08	20		1			H1533	001	0	2016	StayWell Senior Care		2		2			2								www.staywellseniorcare.org	www.carekinesis.com									(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	05/21/2015	2016.01	05/21/2015 01:21:38 PM Eastern Daylight Time		05/19/2015 05:12:40 PM Eastern Daylight Time			05/21/2015 01:23:35 PM Eastern Daylight Time	STAYWELL SENIOR CARE, INC.	StayWell Senior Care	www.staywellseniorcare.org	StayWell Senior Care - Medicare Only (PACE)	08	20		1			H1533	002	0	2016	StayWell Senior Care		2		2			2								www.staywellseniorcare.org	www.carekinesis.com									(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	001	0	1	04	01	H1537_001_0	3		1	07/31/2015	2016.01	07/31/2015 03:46:21 PM Central Daylight Time	07/31/2015 02:23:39 PM Central Daylight Time	07/30/2015 07:46:19 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice (PPO)	01	04		1			H1537	001	0	2016	Madison county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1537	801	0	1	04	01	H1537_801_0	1		1	04/13/2015	2016.01	04/13/2015 11:41:19 AM Central Daylight Time	05/29/2015 03:03:42 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	801	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	802	0	1	04	01	H1537_802_0	1		1	04/14/2015	2016.01	04/14/2015 12:00:01 PM Central Daylight Time	05/29/2015 03:10:22 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	802	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H1537	803	0	1	04	01	H1537_803_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:20 PM Central Daylight Time	05/29/2015 03:04:42 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	803	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	804	0	2	04	01	H1537_804_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:22 PM Central Daylight Time	05/29/2015 03:05:12 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	804	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	805	0	2	04	01	H1537_805_0	1		1	04/16/2015	2016.01	04/16/2015 08:27:19 AM Central Daylight Time	05/29/2015 03:05:41 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	805	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H1537	806	0	2	04	01	H1537_806_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:24 PM Central Daylight Time	05/29/2015 03:06:11 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	806	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	807	0	1	04	01	H1537_807_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:26 PM Central Daylight Time	05/29/2015 03:06:39 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	807	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	808	0	1	04	01	H1537_808_0	1		1	04/16/2015	2016.01	04/16/2015 08:27:26 AM Central Daylight Time	05/29/2015 03:10:50 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	808	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H1537	809	0	1	04	01	H1537_809_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:28 PM Central Daylight Time	05/29/2015 03:11:18 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	809	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	816	0	1	04	01	H1537_816_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:29 PM Central Daylight Time	05/29/2015 03:11:45 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	816	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	817	0	1	04	01	H1537_817_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:31 PM Central Daylight Time	05/29/2015 03:12:12 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	817	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	823	0	1	04	01	H1537_823_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:32 PM Central Daylight Time	05/29/2015 03:12:42 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	823	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	824	0	1	04	01	H1537_824_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:33 PM Central Daylight Time	05/29/2015 03:13:11 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	824	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	825	0	1	04	01	H1537_825_0	1		1	04/16/2015	2016.01	04/16/2015 08:27:35 AM Central Daylight Time	05/29/2015 03:13:41 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	825	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H1537	826	0	1	04	01	H1537_826_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:36 PM Central Daylight Time	05/29/2015 03:14:11 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	826	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	827	0	2	04	01	H1537_827_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:37 PM Central Daylight Time	05/29/2015 03:14:42 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	827	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1537	828	0	2	04	01	H1537_828_0	1		1	04/16/2015	2016.01	04/16/2015 08:27:46 AM Central Daylight Time	05/29/2015 03:15:12 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	828	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H1537	829	0	2	04	01	H1537_829_0	1		1	04/13/2015	2016.01	04/13/2015 12:05:40 PM Central Daylight Time	05/29/2015 03:15:42 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	829	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1587	001	0	1	01	01	H1587_001_0	6	2	1	08/05/2015	2016.01	08/05/2015 01:48:31 PM Central Daylight Time	08/05/2015 02:03:00 PM Central Daylight Time	08/05/2015 02:03:00 PM Central Daylight Time			08/05/2015 02:04:23 PM Central Daylight Time	ARKANSAS SUPERIOR SELECT, INC.	Tribute Health Plan of Arkansas	www.tributehealthplans.com	Tribute Health Plan of Arkansas (HMO SNP)	01	01		1			H1587	001	0	2016	Northern Arkansas		2	1044	2			1	3		1	3		1	www.tributehealthplans.com	www.tributehealthplans.com	www.tributehealthplans.com	(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1607	012	0	1	04	01	H1607_012_0	9		1	07/16/2015	2016.01	07/16/2015 04:19:11 PM Eastern Daylight Time	08/01/2015 09:18:53 PM Eastern Daylight Time	07/30/2015 06:13:10 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H1607	012	0	2016	Select Counties in Indiana		2	1510	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)558-1438		(855)558-1438		(800)797-6421		(800)797-6421		(855)558-1438		(855)558-1438		(844)364-2110		(844)364-2110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1607	804	0	1	04	01	H1607_804_0	4		1	05/29/2015	2016.01	05/29/2015 12:14:59 PM Pacific Daylight Time	05/31/2015 09:38:28 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	804	0	2016	Indiana		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H1607	805	0	1	04	01	H1607_805_0	4		1	05/29/2015	2016.01	05/29/2015 12:15:40 PM Pacific Daylight Time	05/31/2015 01:15:47 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	805	0	2016	Indiana		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H1607	806	0	1	04	01	H1607_806_0	4		1	05/29/2015	2016.01	05/29/2015 12:14:50 PM Pacific Daylight Time	05/31/2015 01:15:52 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	806	0	2016	Indiana		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H1608	001	0	1	04	01	H1608_001_0	5		1	07/31/2015	2016.01	07/31/2015 10:28:20 AM Central Daylight Time	08/02/2015 08:06:21 PM Eastern Daylight Time	07/29/2015 04:58:58 PM Eastern Daylight Time			08/03/2015 11:25:45 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum (PPO)	01	04		1			H1608	001	0	2016	Partial State of Iowa and South Dakota		2	24300	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(866)293-4748		(866)293-4748		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	004	0	1	04	01	H1608_004_0	5		1	07/31/2015	2016.01	07/31/2015 10:28:35 AM Central Daylight Time	08/02/2015 07:08:00 PM Central Daylight Time	07/29/2015 03:59:17 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (PPO)	01	04		1			H1608	004	0	2016	Lincoln, McCook, Minnehaha Counties South Dakota		2	658	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(866)293-4748		(866)293-4748		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	007	0	1	04	01	H1608_007_0	5		1	07/31/2015	2016.01	07/31/2015 10:28:56 AM Central Daylight Time	08/02/2015 07:09:22 PM Central Daylight Time	07/29/2015 03:59:36 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (PPO)	01	04		1			H1608	007	0	2016	Marshall and Story Counties Iowa		2	500	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(866)293-4748		(866)293-4748		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	008	0	1	04	01	H1608_008_0	6		1	07/31/2015	2016.01	07/31/2015 10:29:13 AM Central Daylight Time	08/02/2015 07:10:53 PM Central Daylight Time	07/29/2015 03:59:55 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (PPO)	01	04		1			H1608	008	0	2016	Ida, Monona, Plymouth, Woodbury Counties Iowa		2	500	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(866)293-4748		(866)293-4748		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	012	0	1	04	01	H1608_012_0	5		1	07/31/2015	2016.01	07/31/2015 10:29:32 AM Central Daylight Time	08/02/2015 07:12:17 PM Central Daylight Time	07/29/2015 04:00:14 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum (PPO)	01	04		1			H1608	012	0	2016	Partial State of Nebraska		2	3692	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(800)707-7052		(800)707-7052		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	013	0	1	04	01	H1608_013_0	6		1	07/31/2015	2016.01	07/31/2015 07:42:23 PM Central Daylight Time	07/31/2015 07:35:12 PM Central Daylight Time	07/29/2015 04:00:33 PM Central Daylight Time			08/02/2015 10:57:20 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.chcmissourimedicare.com	Advantra (PPO)	01	04		1			H1608	013	0	2016	St. Louis Metro		2	373	2			2							www.providerdirectory.coventry-medicare.com	www.moformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(877)417-8652		(877)417-8652		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	016	0	1	04	01	H1608_016_0	3		1	07/31/2015	2016.01	07/31/2015 03:53:00 PM Central Daylight Time	08/02/2015 04:35:50 PM Central Daylight Time	07/29/2015 04:00:51 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Freedom (PPO)	01	04		1			H1608	016	0	2016	KC Metro (Kansas & Missouri) Counties		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	017	0	1	04	01	H1608_017_0	4		1	07/31/2015	2016.01	07/31/2015 03:48:22 PM Central Daylight Time	08/02/2015 05:37:06 PM Central Daylight Time	07/29/2015 04:01:10 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Medicare Advantage (PPO)	01	04		1			H1608	017	0	2016	Wichita (Kansas) Metro Counties		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	018	0	1	04	01	H1608_018_0	3		1	07/31/2015	2016.01	07/31/2015 03:54:55 PM Central Daylight Time	08/02/2015 04:37:52 PM Central Daylight Time	07/29/2015 04:01:28 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Freedom (PPO)	01	04		1			H1608	018	0	2016	South East Kansas & South West Missouri Area		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	021	0	1	04	01	H1608_021_0	3		1	07/31/2015	2016.01	07/31/2015 05:36:49 PM Central Daylight Time	08/02/2015 04:40:14 PM Central Daylight Time	07/29/2015 04:01:47 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Freedom (PPO)	01	04		1			H1608	021	0	2016	Central Oklahoma & North West Arkansas Area		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	023	0	1	04	01	H1608_023_0	3		1	07/31/2015	2016.01	07/31/2015 06:50:32 PM Central Daylight Time	08/02/2015 04:44:43 PM Central Daylight Time	07/29/2015 04:02:05 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Freedom Plus (PPO)	01	04		1			H1608	023	0	2016	North East Kansas and KC Metro (KS & MO) Counties		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	024	0	1	04	01	H1608_024_0	4		1	07/31/2015	2016.01	07/31/2015 05:44:04 PM Central Daylight Time	08/02/2015 04:46:39 PM Central Daylight Time	07/29/2015 04:02:24 PM Central Daylight Time			08/02/2015 09:51:33 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Total Care (PPO)	01	04		1			H1608	024	0	2016	North East (Topeka Area) Kansas		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	025	0	1	04	01	H1608_025_0	6		1	07/31/2015	2016.01	07/31/2015 09:52:24 PM Eastern Daylight Time	08/04/2015 03:56:17 PM Eastern Daylight Time	07/29/2015 05:02:43 PM Eastern Daylight Time			08/04/2015 04:13:13 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.nc.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H1608	025	0	2016	North Carolina		2	10000	2			2							http://iowa-nebraska.chcadvantra.com	http://coventry-medicare.coventryhealthcare.com/advantra-iowa-nebraska/prescription-drug-benefits/fo	http://PharmacyLocator.coventry-medicare.com	(866)731-9574		(866)731-9574		(855)338-9551		(855)338-9551		(877)300-5134		(877)300-5134		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	026	0	1	04	01	H1608_026_0	6		1	07/31/2015	2016.01	07/31/2015 08:20:10 PM Eastern Daylight Time	08/02/2015 11:28:53 AM Eastern Daylight Time	07/29/2015 05:03:02 PM Eastern Daylight Time			08/03/2015 09:14:58 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.wv.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H1608	026	0	2016	Northern West Virginia		2	800	2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(866)295-6206		(866)295-6206		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	027	0	1	04	01	H1608_027_0	6		1	07/31/2015	2016.01	07/31/2015 08:20:51 PM Eastern Daylight Time	08/02/2015 11:30:19 AM Eastern Daylight Time	07/29/2015 05:03:20 PM Eastern Daylight Time			08/03/2015 09:14:58 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.wv.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H1608	027	0	2016	Southern West Virginia		2	800	2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(866)295-6206		(866)295-6206		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	028	0	1	04	01	H1608_028_0	9		1	07/31/2015	2016.01	07/31/2015 11:03:44 AM Eastern Daylight Time	07/31/2015 12:54:06 PM Eastern Daylight Time	07/29/2015 05:03:39 PM Eastern Daylight Time			08/01/2015 05:48:36 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://iowa-nebraska.chcadvantra.com	Advantra Preferred (PPO)	01	04		1			H1608	028	0	2016	Atlanta, Savannah, Augusta and Columbus areas		2	1000	2			2							http://Providerdirectory.Coventry-Medicare.com	http://GAformulary.Coventry-Medicare.com	http://pharmacylocator.coventry-medicare.com	(866)613-4977		(866)613-4977		(855)338-9551		(855)338-9551		(800)690-3412		(800)690-3412		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	029	0	1	04	01	H1608_029_0	9		1	08/01/2015	2016.01	08/01/2015 11:13:42 AM Eastern Daylight Time	08/04/2015 10:50:07 AM Eastern Daylight Time	07/29/2015 05:03:58 PM Eastern Daylight Time			08/04/2015 11:37:07 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.pa.chcadvantra.com	Advantra Silver (PPO)	01	04		1			H1608	029	0	2016	Northeastern OH		2	10960	2			2							http://www.providerdirectory.coventry-medicare.com	http://www.PAFormulary.coventry-medicare.com	http://www.pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551		(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	030	0	1	04	01	H1608_030_0	6		1	08/01/2015	2016.01	08/01/2015 12:07:19 AM Eastern Daylight Time	08/02/2015 08:47:55 PM Eastern Daylight Time	07/29/2015 05:04:17 PM Eastern Daylight Time			08/03/2015 01:26:04 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H1608	030	0	2016	Northeastern OH		2	2064	2			2							http://www.providerdirectory.coventry-medicare.com	http://www.PAFormulary.coventry-medicare.com	http://www.pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551		(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	801	0	1	04	01	H1608_801_0	2		1	05/26/2015	2016.01	05/26/2015 12:31:47 PM Central Daylight Time	07/16/2015 04:28:12 PM Central Daylight Time				07/16/2015 04:51:19 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum EmpGrp/NoRx/Cyear (PPO)	01	04		1			H1608	801	0	2016	Partial State of Iowa and South Dakota		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	802	0	1	04	01	H1608_802_0	2		1	04/17/2015	2016.01	04/17/2015 12:42:15 PM Central Daylight Time	07/16/2015 04:28:13 PM Central Daylight Time				07/16/2015 04:51:19 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum EmpGrp/Rx/Cyear (PPO)	01	04		1			H1608	802	0	2016	Partial State of Iowa and South Dakota		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(866)293-4748		(866)293-4748		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	814	0	1	04	01	H1608_814_0	2		1	05/26/2015	2016.01	05/26/2015 12:28:39 PM Central Daylight Time	07/16/2015 04:28:13 PM Central Daylight Time				07/16/2015 04:51:19 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.chcmissourimedicare.com	St. Louis Employer Group w/o Rx (PPO)	01	04		1			H1608	814	0	2016	St Louis		1	0	2			2							www.providerdirectory.coventry-medicare.com	www.moformulary.coventry-medicare.com	www.providerdirectory.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	815	0	1	04	01	H1608_815_0	2		1	04/17/2015	2016.01	05/26/2015 12:30:12 PM Central Daylight Time	07/16/2015 04:28:13 PM Central Daylight Time				07/16/2015 04:51:19 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.chcmissourimedicare.com	St. Louis Employer Group w/Rx (PPO)	01	04		1			H1608	815	0	2016	St. Louis		1	0	2			2							www.providerdirectory.coventry-medicare.com	www.moformulary.coventry-medicare.com	www.providerdirectory.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(877)417-8652		(877)417-8652		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	816	0	1	04	01	H1608_816_0	3		1	07/16/2015	2016.01	07/16/2015 07:32:32 PM Eastern Daylight Time	07/15/2015 10:01:51 PM Eastern Daylight Time				07/16/2015 07:34:18 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://iowa-nebraska.chcadvantra.com	Ohio Employer Group w/Rx (PPO)	01	04		1			H1608	816	0	2016	Ohio		1		2			2							http://iowa-nebraska.chcadvantra.com	http://coventry-medicare.coventryhealthcare.com/advantra-iowa-nebraska/prescription-drug-benefits/fo	http://PharmacyLocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551		(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	817	0	1	04	01	H1608_817_0	2		1	05/26/2015	2016.01	05/26/2015 12:32:34 PM Central Daylight Time	07/16/2015 04:28:14 PM Central Daylight Time				07/16/2015 04:51:19 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Heartland Employer Group w/o Rx (PPO)	01	04		1			H1608	817	0	2016	Heartland		1	0	2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	818	0	1	04	01	H1608_818_0	2		1	07/16/2015	2016.01	07/16/2015 07:32:36 PM Eastern Daylight Time	07/15/2015 10:03:31 PM Eastern Daylight Time				07/16/2015 07:34:18 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://iowa-nebraska.chcadvantra.com	Ohio Employer Group w/o Rx (PPO)	01	04		1			H1608	818	0	2016	Ohio		1	500	2			2							http://iowa-nebraska.chcadvantra.com	http://coventry-medicare.coventryhealthcare.com/advantra-iowa-nebraska/prescription-drug-benefits/fo	http://PharmacyLocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	819	0	1	04	01	H1608_819_0	2		1	04/17/2015	2016.01	05/26/2015 12:33:57 PM Central Daylight Time	07/16/2015 04:28:12 PM Central Daylight Time				07/16/2015 04:51:19 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Heartland Employer Group w/Rx (PPO)	01	04		1			H1608	819	0	2016	Heartland		1	0	2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	822	0	1	04	01	H1608_822_0	2		1	05/27/2015	2016.01	05/27/2015 04:27:53 PM Eastern Daylight Time	07/16/2015 05:28:44 PM Eastern Daylight Time				07/16/2015 07:57:53 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra MA Only (PPO)	01	04		1			H1608	822	0	2016	West Virginia		1		2			2							http://iowa-nebraska.chcadvantra.com	http://coventry-medicare.coventryhealthcare.com/advantra-iowa-nebraska/prescription-drug-benefits/fo	http://PharmacyLocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(800)470-4272		(800)470-4272										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	823	0	1	04	01	H1608_823_0	2		1	05/27/2015	2016.01	05/27/2015 04:30:24 PM Eastern Daylight Time	07/16/2015 05:28:45 PM Eastern Daylight Time				07/16/2015 07:57:53 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H1608	823	0	2016	West Virginia		1		2			2							http://iowa-nebraska.chcadvantra.com	http://coventry-medicare.coventryhealthcare.com/advantra-iowa-nebraska/prescription-drug-benefits/fo	http://PharmacyLocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(800)470-4272		(800)470-4272		(866)295-6206		(866)295-6206		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1608	824	0	1	04	01	H1608_824_0	2		1	05/29/2015	2016.01	05/29/2015 03:22:54 PM Eastern Daylight Time	07/16/2015 05:28:45 PM Eastern Daylight Time				07/16/2015 08:55:06 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://iowa-nebraska.chcadvantra.com	Coventry Advantra (PPO)	01	04		1			H1608	824	0	2016	North Carolina		1	50	2			2							http://iowa-nebraska.chcadvantra.com	http://coventry-medicare.coventryhealthcare.com/advantra-iowa-nebraska/prescription-drug-benefits/fo	http://PharmacyLocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(800)470-4272		(800)470-4272		(866)295-6206		(866)295-6206		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1609	001	0	1	01	01	H1609_001_0	5		1	07/31/2015	2016.01	07/31/2015 10:31:06 AM Central Daylight Time	08/02/2015 07:13:45 PM Central Daylight Time	07/29/2015 04:04:36 PM Central Daylight Time			08/02/2015 10:02:53 PM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver (HMO)	01	01		1			H1609	001	0	2016	Partial State of Iowa		2	3600	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(866)294-1211		(866)294-1211		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	009	0	1	01	01	H1609_009_0	5		1	07/31/2015	2016.01	07/31/2015 10:31:20 AM Central Daylight Time	08/02/2015 07:18:00 PM Central Daylight Time	07/29/2015 04:04:55 PM Central Daylight Time			08/02/2015 10:02:53 PM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (HMO)	01	01		1			H1609	009	0	2016	Dallas, Polk, Warren Counties Iowa		2	542	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(866)294-1211		(866)294-1211		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	010	0	1	01	01	H1609_010_0	5		1	07/31/2015	2016.01	07/31/2015 10:31:44 AM Central Daylight Time	08/02/2015 07:20:09 PM Central Daylight Time	07/29/2015 04:05:13 PM Central Daylight Time			08/02/2015 10:02:53 PM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (HMO)	01	01		1			H1609	010	0	2016	Pottawattamie County Iowa		2	175	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(866)294-1211		(866)294-1211		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	801	0	1	01	01	H1609_801_0	1		1	04/17/2015	2016.01	04/17/2015 12:42:47 PM Central Daylight Time	05/28/2015 08:14:51 AM Central Daylight Time				05/28/2015 10:38:33 AM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/NoRx/Cyear (HMO)	01	01		1			H1609	801	0	2016	Partial State of Iowa		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1					1	2			
H1609	802	0	1	01	01	H1609_802_0	1		1	05/07/2015	2016.01	05/07/2015 08:08:52 AM Central Daylight Time	05/28/2015 08:16:42 AM Central Daylight Time				05/28/2015 10:38:33 AM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/Rx/Cyear (HMO)	01	01		1			H1609	802	0	2016	Partial State of Iowa		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(866)294-1211		(866)294-1211		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H1651	001	0	1	18	06	H1651_001_0	4		2	07/31/2015	2016.01	07/31/2015 09:53:20 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates SmartPlan (Cost)	06	18		1			H1651	001	0	2016	Northeast Iowa		2	5500	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H1651	002	0	1	18	06	H1651_002_0	3		2	07/31/2015	2016.01	07/31/2015 09:55:16 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Basic Plan (Cost)	06	18		1			H1651	002	0	2016	Northeast Iowa		2	5	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H1651	003	0	1	18	06	H1651_003_0	3		2	07/31/2015	2016.01	07/31/2015 09:56:40 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates SmartPlan (Cost)	06	18		1			H1651	003	0	2016	Jo Daviess County		2	1170	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H1651	004	0	1	18	06	H1651_004_0	4		2	07/31/2015	2016.01	07/31/2015 09:57:55 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Community Plan (Cost)	06	18		1			H1651	004	0	2016	Northeast Iowa		2	2875	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H1651	005	0	1	18	06	H1651_005_0	3		2	07/31/2015	2016.01	07/31/2015 09:58:58 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Community Plan (Cost)	06	18		1			H1651	005	0	2016	Jo Daviess County		2	405	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H1651	008	0	1	18	06	H1651_008_0	4		2	07/31/2015	2016.01	07/31/2015 10:00:01 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Freedom Plan (Cost)	06	18		1			H1651	008	0	2016	Northeast Iowa		2	480	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H1651	009	0	1	18	06	H1651_009_0	3		2	07/31/2015	2016.01	07/31/2015 10:00:58 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Freedom Plan (Cost)	06	18		1			H1651	009	0	2016	Jo Daviess County		2	120	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H1659	001	0	1	04	01	H1659_001_0	5		1	06/30/2015	2016.01	06/30/2015 02:20:21 PM Eastern Daylight Time	07/30/2015 02:50:24 PM Eastern Daylight Time	07/30/2015 02:49:58 PM Eastern Daylight Time			08/04/2015 08:11:23 AM Eastern Daylight Time	PIEDMONT COMMUNITY HEALTHCARE, INC.	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option One (PPO)	01	04		1			H1659	001	0	2016	Cities: LYH,BE Counties: AM,AP,BE,CA,CLT,HA,PE,PI		2	1314	2			2							www.pchp.net	www.pchp.net	www.pchp.net	(877)210-1719		(434)947-3671		(877)210-1719		(434)947-3671		(866)494-9927		(866)494-9927		(877)210-1719		(434)947-3671		(877)295-1454		(877)295-1454		(877)295-1454		(877)295-1454		(866)236-1069		(866)236-1069		(877)295-1454		(877)295-1454		2					2						2			
H1659	002	0	1	04	01	H1659_002_0	6		1	06/30/2015	2016.01	06/30/2015 02:24:18 PM Eastern Daylight Time	07/30/2015 02:49:33 PM Eastern Daylight Time	07/30/2015 02:49:10 PM Eastern Daylight Time			08/04/2015 08:11:23 AM Eastern Daylight Time	PIEDMONT COMMUNITY HEALTHCARE, INC.	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option Two (PPO)	01	04		1			H1659	002	0	2016	Cities:LYH,BE Counties:AM,AP,BE,CA,CLT,HA,PE,PI		2	2625	2			2							www.pchp.net	www.pchp.net	www.pchp.net	(877)210-1719		(434)947-3671		(877)210-1719		(434)947-3671		(866)494-9927		(866)494-9927		(877)210-1719		(434)947-3671		(877)295-1454		(877)295-1454		(877)295-1454		(877)295-1454		(866)236-1069		(866)236-1069		(877)295-1454		(877)295-1454		2					2						2			
H1659	003	0	1	04	01	H1659_003_0	5		1	06/30/2015	2016.01	06/30/2015 02:26:23 PM Eastern Daylight Time	07/30/2015 02:48:57 PM Eastern Daylight Time	07/30/2015 02:50:47 PM Eastern Daylight Time			08/04/2015 08:11:23 AM Eastern Daylight Time	PIEDMONT COMMUNITY HEALTHCARE, INC.	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option Three (PPO)	01	04		1			H1659	003	0	2016	Cities: LYH,BE Counties: AM,AP,BE,CA,CLT,HA,PE,PI		2	2534	2			2							www.pchp.net	www.pchp.net	www.pchp.net	(877)210-1719		(434)947-3671		(877)210-1719		(434)947-3671		(866)494-9927		(866)494-9927		(877)210-1719		(434)947-3671		(877)295-1454		(877)295-1454		(877)295-1454		(877)295-1454		(866)236-1069		(866)236-1069		(877)295-1454		(877)295-1454		2					2						2			
H1660	001	0	1	01	01	H1660_001_0	6		1	08/04/2015	2016.01	08/04/2015 12:35:07 PM Eastern Daylight Time	08/03/2015 04:00:31 PM Eastern Daylight Time	07/31/2015 02:13:45 PM Eastern Daylight Time			08/04/2015 05:44:24 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	001	0	2016	Eastern Massachusetts		2	757	2			2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	004	0	1	01	01	H1660_004_0	6		1	07/14/2015	2016.01	07/14/2015 11:29:56 AM Eastern Daylight Time	08/03/2015 04:01:20 PM Eastern Daylight Time	07/31/2015 02:15:45 PM Eastern Daylight Time			08/04/2015 05:44:24 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	004	0	2016	Central Massachusetts		2	758	2			2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	005	0	1	01	01	H1660_005_0	6		1	07/14/2015	2016.01	07/14/2015 11:30:25 AM Eastern Daylight Time	08/03/2015 04:02:58 PM Eastern Daylight Time	07/31/2015 02:18:47 PM Eastern Daylight Time			08/04/2015 05:44:24 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	005	0	2016	Southern Maine		2	90	2			2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	009	0	1	01	01	H1660_009_0	6		1	07/14/2015	2016.01	07/14/2015 11:30:51 AM Eastern Daylight Time	08/03/2015 03:42:12 PM Eastern Daylight Time	07/31/2015 02:05:32 PM Eastern Daylight Time			08/04/2015 05:44:24 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	009	0	2016	Eastern Massachusetts		2	2272	2			2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	012	0	1	01	01	H1660_012_0	7		1	07/14/2015	2016.01	07/14/2015 11:39:16 AM Eastern Daylight Time	08/03/2015 03:37:18 PM Eastern Daylight Time	07/31/2015 02:06:46 PM Eastern Daylight Time			08/04/2015 05:44:24 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	012	0	2016	Central Massachusetts		2	2272	2			2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	013	0	1	01	01	H1660_013_0	8		1	08/04/2015	2016.01	08/04/2015 05:26:12 PM Eastern Daylight Time	08/03/2015 03:43:47 PM Eastern Daylight Time	07/31/2015 02:08:58 PM Eastern Daylight Time			08/04/2015 05:44:24 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	013	0	2016	Southern Maine		2	90	2			2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	801	0	1	01	01	H1660_801_0	4		1	07/14/2015	2016.01	07/14/2015 10:54:30 AM Eastern Daylight Time	07/15/2015 06:10:50 PM Eastern Daylight Time				07/21/2015 01:24:18 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	801	0	2016	Massachusetts & Maine		1	67	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)-		1	2		2		1					1	2			
H1660	802	0	1	01	01	H1660_802_0	4		1	05/07/2015	2016.01	05/07/2015 11:25:19 AM Eastern Daylight Time	07/15/2015 06:10:57 PM Eastern Daylight Time				07/21/2015 01:24:18 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	802	0	2016	Massachusetts & Maine		1	67	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)-		1	2		2		1					1	2			
H1660	803	0	1	01	01	H1660_803_0	4		1	05/07/2015	2016.01	05/07/2015 11:25:49 AM Eastern Daylight Time	07/15/2015 06:11:04 PM Eastern Daylight Time				07/21/2015 01:24:18 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	803	0	2016	Massachusetts & Maine		1	67	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)-		1	2		2		1					1	2			
H1660	804	0	1	01	01	H1660_804_0	3		1	05/07/2015	2016.01	05/07/2015 11:25:59 AM Eastern Daylight Time	07/15/2015 06:11:12 PM Eastern Daylight Time				07/20/2015 11:25:16 AM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	804	0	2016	Massachusetts & Maine		1	67	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)-		1	2		2		1					1	2			
H1666	001	0	1	04	01	H1666_001_0	7		1	07/16/2015	2016.01	07/16/2015 01:00:59 PM Central Daylight Time	08/03/2015 03:24:56 PM Central Daylight Time	08/03/2015 02:17:42 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	001	0	2016	Austin metro area		2		2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	002	0	1	04	01	H1666_002_0	7		1	07/16/2015	2016.01	07/16/2015 01:01:30 PM Central Daylight Time	08/03/2015 03:25:30 PM Central Daylight Time	08/03/2015 02:21:26 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	002	0	2016	Dallas, Tarrant, Collin, and Denton counties		2		2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	003	0	1	04	01	H1666_003_0	6		1	07/16/2015	2016.01	07/16/2015 01:02:09 PM Central Daylight Time	08/03/2015 03:26:04 PM Central Daylight Time	08/03/2015 02:20:44 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	003	0	2016	Harris, Fort Bend, and Montgomery counties		2		2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	004	0	1	04	01	H1666_004_0	6		1	07/16/2015	2016.01	07/16/2015 01:02:29 PM Central Daylight Time	08/03/2015 03:26:38 PM Central Daylight Time	08/03/2015 02:16:52 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	004	0	2016	Austin Metro Area		2		2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	005	0	1	04	01	H1666_005_0	6		1	07/16/2015	2016.01	07/16/2015 01:02:44 PM Central Daylight Time	08/03/2015 04:32:30 PM Central Daylight Time	08/03/2015 02:15:52 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	005	0	2016	Dallas Metro Area		2		2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	006	0	1	04	01	H1666_006_0	6		1	07/16/2015	2016.01	07/16/2015 01:02:56 PM Central Daylight Time	08/03/2015 04:33:04 PM Central Daylight Time	08/03/2015 02:12:54 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	006	0	2016	Houston Metro Area		2		2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	008	0	1	04	01	H1666_008_0	10		1	07/15/2015	2016.01	07/15/2015 04:16:12 PM Central Daylight Time	08/03/2015 03:28:22 PM Central Daylight Time	08/03/2015 02:50:46 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	008	0	2016	San Antonio		2	376	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	009	0	1	04	01	H1666_009_0	11		1	07/17/2015	2016.01	07/17/2015 05:22:48 PM Central Daylight Time	08/03/2015 03:28:56 PM Central Daylight Time	08/03/2015 02:11:52 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Premier (PPO)	01	04		1			H1666	009	0	2016	San Antonio		2	94	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1666	801	0	1	04	01	H1666_801_0	5		1	05/27/2015	2016.01	05/27/2015 11:03:58 AM Central Daylight Time	06/01/2015 12:47:38 PM Central Daylight Time				06/01/2015 01:23:10 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	BlueCross Medicare Advantage (PPO)	01	04		1			H1666	801	0	2016	State of Texas		1	50965	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H1666	803	0	1	04	01	H1666_803_0	3		1	05/27/2015	2016.01	05/27/2015 11:04:07 AM Central Daylight Time	06/01/2015 12:48:51 PM Central Daylight Time				06/01/2015 01:23:10 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	BlueCross  Medicare Advantage (PPO)	01	04		1			H1666	803	0	2016	State of Texas		1	50965	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H1666	805	0	1	04	01	H1666_805_0	3		1	05/27/2015	2016.01	05/27/2015 11:04:15 AM Central Daylight Time	06/01/2015 12:49:37 PM Central Daylight Time				06/01/2015 01:23:10 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.getbluetx.com	BlueCross  Medicare Advantage (PPO)	01	04		1			H1666	805	0	2016	State of Texas		1	50965	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H1692	002	0	1	01	01	H1692_002_0	5		1	07/07/2015	2016.01	07/07/2015 10:45:06 AM Eastern Daylight Time	08/02/2015 11:00:00 AM Eastern Daylight Time	07/29/2015 05:05:32 PM Eastern Daylight Time			08/03/2015 09:20:20 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	www.wv.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H1692	002	0	2016	Southern West Virginia		2	1410	2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(866)295-6206		(866)295-6206		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	003	0	1	01	01	H1692_003_0	3		1	07/31/2015	2016.01	07/31/2015 08:21:59 PM Eastern Daylight Time	08/02/2015 11:00:44 AM Eastern Daylight Time	07/29/2015 05:05:51 PM Eastern Daylight Time			08/03/2015 09:20:20 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	www.wv.chcadvantra.com	Advantra Choice (HMO)	01	01		1			H1692	003	0	2016	Northern West Virginia		2	274	2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(866)295-6206		(866)295-6206		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	004	0	1	01	01	H1692_004_0	3		1	07/31/2015	2016.01	07/31/2015 08:22:33 PM Eastern Daylight Time	08/02/2015 11:01:43 AM Eastern Daylight Time	07/29/2015 05:06:10 PM Eastern Daylight Time			08/03/2015 09:20:20 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	www.wv.chcadvantra.com	Advantra Choice (HMO)	01	01		1			H1692	004	0	2016	Southern West Virginia		2	231	2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(855)338-9551		(855)338-9551		(866)295-6206		(866)295-6206		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	801	0	1	01	01	H1692_801_0	2		1	05/28/2015	2016.01	05/28/2015 08:59:32 AM Eastern Daylight Time	07/17/2015 10:28:31 AM Eastern Daylight Time				07/17/2015 11:09:39 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra MA Only (HMO)	01	01		1			H1692	801	0	2016	West Virginia		1		2			2							http://providerdirectory.coventry-medicare.com	http://WVFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(800)470-4272		(800)470-4272										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1					1	2			
H1692	802	0	1	01	01	H1692_802_0	2		1	05/28/2015	2016.01	05/28/2015 09:02:49 AM Eastern Daylight Time	07/17/2015 10:28:31 AM Eastern Daylight Time				07/17/2015 11:09:39 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H1692	802	0	2016	West Virginia		1		2			2							http://providerdirectory.coventry-medicare.com	http://WVFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(800)470-4272		(800)470-4272		(866)295-6206		(866)295-6206		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1					1	2			
H1714	001	0	1	20	08	H1714_001_0	1		1	05/20/2015	2016.01	05/20/2015 09:31:54 AM Central Daylight Time		05/19/2015 07:49:15 AM Central Daylight Time			05/20/2015 09:43:03 AM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR ELDERS	Via Christi HOPE	www.via-christ.org/hope	Via Christi HOPE (PACE)	08	20		1			H1714	001	0	2016	Via Christi HOPE		2		2			2								www.viachristihope.com	www.viachristihope.com									(316)858-1111		(316)858-1111		(316)858-1111		(316)858-1111										(316)858-1111		(316)858-1111		(316)858-1111		(316)858-1111																
H1714	002	0	1	20	08	H1714_002_0	1		1	05/20/2015	2016.01	05/20/2015 09:32:37 AM Central Daylight Time		05/19/2015 07:50:23 AM Central Daylight Time			05/20/2015 09:43:03 AM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR ELDERS	Via Christi HOPE	www.via-christ.org/hope	Via Christi HOPE (PACE)	08	20		1			H1714	002	0	2016	Sedgwick Co, KS		2		2			2								www.viachristihope.com	www.viachristihope.com									(316)858-1111		(316)858-1111		(316)858-1111		(316)858-1111										(316)858-1111		(316)858-1111		(316)858-1111		(316)858-1111																
H1716	001	0	1	04	01	H1716_001_0	3		1	07/09/2015	2016.01	07/09/2015 03:36:47 PM Eastern Daylight Time	08/03/2015 10:41:50 AM Eastern Daylight Time	07/29/2015 09:51:34 PM Eastern Daylight Time			08/04/2015 12:55:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1716-001 (PPO)	01	04		1			H1716	001	0	2016	Kansas City Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1723	001	0	1	48	05	H1723_001_0	9		1	09/09/2015	2016.01	09/09/2015 07:56:27 AM Central Daylight Time					09/09/2015 09:04:02 AM Central Daylight Time	ABSOLUTE TOTAL CARE, INC.	Absolute Total Care	http://mmp.absolutetotalcare.com	Absolute Total Care (Medicare-Medicaid Plan)	05	48		1			H1723	001	0	2016	Statewide		2	500	2			2							http://apps.absolutetotalcare.com/findadoc	http://mmp.absolutetotalcare.com/home/prescription-drug-part-d-benefit-information/	http://apps.absolutetotalcare.com/findadoc	(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)-		2					2					2				
H1737	001	0	1	01	01	H1737_001_0	4		1	07/01/2015	2016.01	07/01/2015 07:57:56 AM Central Daylight Time	08/03/2015 09:33:12 AM Central Daylight Time	08/02/2015 05:03:00 PM Central Daylight Time			08/04/2015 03:09:05 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Guide HMO Rx (HMO)	01	01		1			H1737	001	0	2016	Sarpy, NE, Douglas, NE, Pottawattamie, IA		2	498	2			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		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		2					2					2	2			
H1737	003	0	1	01	01	H1737_003_0	5		1	07/01/2015	2016.01	07/01/2015 07:59:46 AM Central Daylight Time	08/03/2015 09:33:54 AM Central Daylight Time	08/02/2015 05:03:33 PM Central Daylight Time			08/04/2015 03:09:05 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Guide Plus HMO Rx (HMO)	01	01		1			H1737	003	0	2016	Sarpy, NE, Douglas, NE, Pottawattamie, IA		2	512	2			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		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		2					2					2	2			
H1737	801	0	1	01	01	H1737_801_0	2		1	05/14/2015	2016.01	05/14/2015 09:46:13 AM Central Daylight Time	05/30/2015 04:09:50 PM Central Daylight Time				05/31/2015 08:28:31 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1737	801	0	2016	Sarpy, NE, Douglas, NE, Pottawattamie, IA		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454										(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352										1	2		2		1					1	2			
H1737	802	0	1	01	01	H1737_802_0	2		1	05/14/2015	2016.01	05/14/2015 09:46:23 AM Central Daylight Time	05/30/2015 04:10:39 PM Central Daylight Time				05/31/2015 08:28:31 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	2016	Sarpy, NE, Douglas, NE, Pottawattamie, IA		1	1	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		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		1	2		2		1					1	2			
H1737	803	0	1	01	01	H1737_803_0	2		1	05/14/2015	2016.01	05/14/2015 09:46:44 AM Central Daylight Time	05/30/2015 04:11:29 PM Central Daylight Time				05/31/2015 08:28:31 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO) - non calendar year (HMO)	01	01		1			H1737	803	0	2016	Sarpy, NE, Douglas, NE, Pottawattamie, IA		1	1	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		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		1	2		2		1					1	2			
H1777	007	0	1	01	01	H1777_007_0	5		1	07/22/2015	2016.01	07/22/2015 03:02:50 PM Eastern Daylight Time	08/03/2015 11:26:42 AM Eastern Daylight Time	08/03/2015 11:10:20 AM Eastern Daylight Time			08/04/2015 10:18:19 AM Eastern Daylight Time	CATHOLIC SPECIAL NEEDS PLAN, LLC	ArchCare Advantage	www.archcareadvantage.org	ArchCare  Advantage (HMO SNP)	01	01		1			H1777	007	0	2016	NYC, Westchester, Putnam, Dutchess, Orange, Ononda		2	1800	2			1	1	3	1				www.archcareadvantage.org/for_providers.php	www.archcareadvantage.org/formulary.php	www.archcareadvantage.org/pharmacy_access_information.php	(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(888)816-7977		(888)816-7977		(800)373-3177		(800)373-3177		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)236-1069		(800)662-1220		(800)662-1220		2					2					2	2			
H1846	001	0	1	04	01	H1846_001_0	8		1	08/05/2015	2016.01	08/05/2015 09:33:47 AM Eastern Daylight Time	07/30/2015 08:33:44 AM Eastern Daylight Time	07/30/2015 07:31:50 AM Eastern Daylight Time			08/05/2015 09:47:40 AM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	MediGold Network Choice (PPO)	01	04		1			H1846	001	0	2016	Greater Central Ohio and Dayton Area		2	1269	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1846	003	0	1	04	01	H1846_003_0	10		1	08/05/2015	2016.01	08/05/2015 09:34:10 AM Eastern Daylight Time	07/30/2015 07:53:46 AM Eastern Daylight Time	07/30/2015 07:31:34 AM Eastern Daylight Time			08/05/2015 09:47:40 AM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	MediGold Value Choice (PPO)	01	04		1			H1846	003	0	2016	Select Central Ohio and Dayton Area		2	1636	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1846	801	0	1	04	01	H1846_801_0	2		1	06/01/2015	2016.01	06/01/2015 08:42:17 PM Eastern Daylight Time	06/01/2015 05:48:30 PM Eastern Daylight Time				06/02/2015 10:47:34 AM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	EGWP MediGold Network Choice (PPO)	01	04		1			H1846	801	0	2016	Greater Central Ohio and Dayton Area		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H1846	802	0	1	04	01	H1846_802_0	2		1	05/21/2015	2016.01	05/21/2015 05:38:58 PM Eastern Daylight Time	06/01/2015 08:51:04 PM Eastern Daylight Time				06/01/2015 08:55:21 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	EGWP MediGold Network Choice Medical Only (PPO)	01	04		1			H1846	802	0	2016	Greater Central Ohio and Dayton Area		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;11a;	2		1						2			
H1849	017	0	1	01	01	H1849_017_0	8	2	1	08/01/2015	2016.01	08/01/2015 09:40:26 AM Eastern Daylight Time	08/01/2015 09:19:26 PM Eastern Daylight Time	07/30/2015 07:28:48 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H1849	017	0	2016	Select Counties in Kentucky		2	315	2			1	3		1	5			www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)558-1439		(855)558-1439		(844)316-0358		(844)316-0358		(855)558-1439		(855)558-1439		(844)316-0358		(844)316-0358		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1849	018	0	1	01	01	H1849_018_0	8		1	08/01/2015	2016.01	08/01/2015 09:41:17 AM Eastern Daylight Time	08/01/2015 09:20:02 PM Eastern Daylight Time	07/30/2015 06:13:49 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H1849	018	0	2016	Select Counties in Kentucky		2	5986	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)558-1439		(855)558-1439		(800)797-6406		(800)797-6406		(855)558-1439		(855)558-1439		(844)364-2111		(844)364-2111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1849	801	0	1	01	01	H1849_801_0	4		1	05/26/2015	2016.01	05/26/2015 01:40:47 PM Pacific Daylight Time	05/31/2015 03:03:24 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H1849	801	0	2016	Kentucky		1	539	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H1849	803	0	1	01	01	H1849_803_0	3		1	05/30/2015	2016.01	05/30/2015 07:19:21 PM Pacific Daylight Time	05/31/2015 03:03:28 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H1849	803	0	2016	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H1894	001	0	1	01	01	H1894_001_0	10		1	07/31/2015	2016.01	07/31/2015 04:57:12 PM Pacific Daylight Time	08/01/2015 06:20:38 PM Pacific Daylight Time	07/30/2015 04:36:58 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H1894	001	0	2016	King and Snohomish Counties		2	1538	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H1894	002	0	1	01	01	H1894_002_0	10	2	1	08/03/2015	2016.01	08/03/2015 09:50:22 AM Pacific Daylight Time	08/04/2015 05:07:27 PM Pacific Daylight Time	07/30/2015 04:37:42 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H1894	002	0	2016	King and Snohomish Counties		2	274	2			1	3		1	1			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H1903	011	0	1	01	01	H1903_011_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:24:10 PM Eastern Daylight Time	08/03/2015 01:39:42 PM Eastern Daylight Time	08/03/2015 03:52:09 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF LOUISIANA, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H1903	011	0	2016	Select Parishes in LA		2	6357	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)530-9488		(866)530-9488		(866)527-0056		(866)527-0056		(866)530-9488		(866)530-9488		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1903	022	0	1	01	01	H1903_022_0	5		1	08/01/2015	2016.01	08/01/2015 09:37:52 AM Eastern Daylight Time	08/03/2015 01:40:31 PM Eastern Daylight Time	08/03/2015 03:52:39 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF LOUISIANA, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H1903	022	0	2016	Select Parishes in LA		2	3758	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)804-5926		(866)804-5926		(866)527-0056		(866)527-0056		(866)804-5926		(866)804-5926		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1903	025	0	1	01	01	H1903_025_0	5		1	08/01/2015	2016.01	08/01/2015 09:38:05 AM Eastern Daylight Time	08/03/2015 01:41:21 PM Eastern Daylight Time	08/03/2015 03:53:07 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE OF LOUISIANA, INC.	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO)	01	01		1			H1903	025	0	2016	East Baton Rouge, West Baton Rouge Parishes		2		2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)804-5926		(866)804-5926		(866)527-0056		(866)527-0056		(866)804-5926		(866)804-5926		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H1904	001	0	1	20	08	H1904_001_0	3		1	05/28/2015	2016.01	05/28/2015 02:44:15 PM Central Daylight Time		05/28/2015 02:17:25 PM Central Daylight Time			05/28/2015 02:47:32 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	2016	PACE Greater New Orleans		2	156	1	1		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	2		1	05/28/2015	2016.01	05/28/2015 02:44:30 PM Central Daylight Time		05/28/2015 02:17:27 PM Central Daylight Time			05/28/2015 02:47:32 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	2016	PACE Greter New Orleans		2	1	1	1		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																
H1916	001	0	1	48	05	H1916_001_0	4		1	08/10/2015	2016.01	08/10/2015 04:06:54 PM Eastern Daylight Time					08/10/2015 04:07:53 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Fully Integrated Dual Advantage (FIDA) (Medicare-Medicaid Plan)	05	48		1			H1916	001	0	2016	Ki, Qu, Brx, NY, Ri, Wes, Suf, Na		2	200	2			2							http://www.fideliscare.org/apps/providersearch/	http://www.fideliscare.org/	http://www.fideliscare.org/	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		2					2					2				
H1944	001	0	1	01	01	H1944_001_0	4		1	07/31/2015	2016.01	07/31/2015 10:26:33 AM Central Daylight Time	07/31/2015 01:22:28 PM Central Daylight Time	07/30/2015 07:47:02 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	001	0	2016	Middlesex and Suffolk 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	2			
H1944	004	0	1	01	01	H1944_004_0	3		1	07/31/2015	2016.01	07/31/2015 10:27:50 AM Central Daylight Time	07/31/2015 01:22:53 PM Central Daylight Time	07/30/2015 07:47:49 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	004	0	2016	Middlesex and Suffolk 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	2			
H1944	005	0	1	01	01	H1944_005_0	3		1	07/31/2015	2016.01	07/31/2015 10:29:53 AM Central Daylight Time	07/31/2015 01:23:18 PM Central Daylight Time	07/30/2015 07:48:39 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	005	0	2016	Bristol, Hampden, and Plymouth 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	2			
H1944	006	0	1	01	01	H1944_006_0	3		1	07/31/2015	2016.01	07/31/2015 10:31:17 AM Central Daylight Time	07/31/2015 01:23:43 PM Central Daylight Time	07/30/2015 07:49:28 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	006	0	2016	Bristol, Hampden, and Plymouth 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	2			
H1944	007	0	1	01	01	H1944_007_0	3		1	07/31/2015	2016.01	07/31/2015 10:33:02 AM Central Daylight Time	07/31/2015 01:24:07 PM Central Daylight Time	07/30/2015 07:50:16 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	007	0	2016	Essex and Norfolk 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	2			
H1944	008	0	1	01	01	H1944_008_0	3		1	07/31/2015	2016.01	07/31/2015 10:34:17 AM Central Daylight Time	07/31/2015 01:24:31 PM Central Daylight Time	07/30/2015 07:51:03 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	008	0	2016	Essex and Norfolk 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	2			
H1944	009	0	1	01	01	H1944_009_0	3		1	07/31/2015	2016.01	07/31/2015 01:40:08 PM Central Daylight Time	07/31/2015 01:24:55 PM Central Daylight Time	07/30/2015 07:51:50 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1944	009	0	2016	Berks and Bucks 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	2			
H1944	010	0	1	01	01	H1944_010_0	3		1	07/31/2015	2016.01	07/31/2015 01:40:56 PM Central Daylight Time	07/31/2015 01:25:20 PM Central Daylight Time	07/30/2015 07:52:36 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	010	0	2016	West Philadelphia		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	011	0	1	01	01	H1944_011_0	3		1	07/31/2015	2016.01	07/31/2015 01:45:38 PM Central Daylight Time	07/31/2015 01:25:44 PM Central Daylight Time	07/30/2015 07:53:26 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	011	0	2016	West Philadelphia		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	012	0	1	01	01	H1944_012_0	3		1	07/31/2015	2016.01	07/31/2015 01:46:23 PM Central Daylight Time	07/31/2015 01:26:08 PM Central Daylight Time	07/30/2015 07:54:13 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	012	0	2016	Crawford and Erie 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	2			
H1944	013	0	1	01	01	H1944_013_0	3		1	07/31/2015	2016.01	07/31/2015 01:47:06 PM Central Daylight Time	07/31/2015 01:26:32 PM Central Daylight Time	07/30/2015 07:54:59 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	013	0	2016	Crawford and Erie 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	2			
H1944	014	0	1	01	01	H1944_014_0	3		1	07/31/2015	2016.01	07/31/2015 10:35:50 AM Central Daylight Time	07/31/2015 01:26:56 PM Central Daylight Time	07/30/2015 07:55:47 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	014	0	2016	Rhode Island		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	015	0	1	01	01	H1944_015_0	2		1	07/13/2015	2016.01	07/13/2015 08:30:29 AM Central Daylight Time	05/29/2015 04:10:09 PM Central Daylight Time				07/13/2015 02:08:25 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H1944	015	0	2016	Rhode Island		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	2			
H1944	016	0	1	01	01	H1944_016_0	3		1	08/03/2015	2016.01	08/03/2015 10:07:03 AM Central Daylight Time	07/31/2015 01:27:20 PM Central Daylight Time	07/30/2015 07:56:35 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	016	0	2016	Rhode Island		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	017	0	1	01	01	H1944_017_0	3		1	07/31/2015	2016.01	07/31/2015 01:47:51 PM Central Daylight Time	07/31/2015 01:27:43 PM Central Daylight Time	07/30/2015 07:57:25 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	017	0	2016	Select counties in New Hampshire		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	018	0	1	01	01	H1944_018_0	3		1	07/31/2015	2016.01	07/31/2015 01:48:38 PM Central Daylight Time	07/31/2015 01:28:06 PM Central Daylight Time	07/30/2015 07:58:18 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1944	018	0	2016	Select counties in Vermont		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	019	0	1	02	01	H1944_019_0	3		1	07/31/2015	2016.01	07/31/2015 01:49:24 PM Central Daylight Time	07/31/2015 01:28:30 PM Central Daylight Time	07/30/2015 07:59:04 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus (HMO-POS)	01	02		1			H1944	019	0	2016	Select counties in New Hampshire		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	805	0	1	01	01	H1944_805_0	1		1	04/23/2015	2016.01	04/23/2015 02:28:46 PM Central Daylight Time	05/29/2015 04:12:09 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	805	0	2016	Various counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H1944	806	0	1	01	01	H1944_806_0	1		1	04/23/2015	2016.01	04/23/2015 02:29:16 PM Central Daylight Time	05/29/2015 04:12:33 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	806	0	2016	Various counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H1944	807	0	1	01	01	H1944_807_0	1		1	04/23/2015	2016.01	04/23/2015 02:29:39 PM Central Daylight Time	05/29/2015 04:12:58 PM Central Daylight Time				05/30/2015 04:52:45 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1944	807	0	2016	Various counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H1951	001	0	1	01	01	H1951_001_0	4		1	07/08/2015	2016.01	07/08/2015 03:06:06 PM Eastern Daylight Time	08/03/2015 02:00:28 PM Eastern Daylight Time	07/30/2015 11:26:02 AM Eastern Daylight Time			08/04/2015 01:19:58 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-001 (HMO)	01	01		1			H1951	001	0	2016	New Orleans Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	005	0	1	01	01	H1951_005_0	3		1	07/07/2015	2016.01	07/07/2015 04:15:40 PM Eastern Daylight Time	08/03/2015 01:50:31 PM Eastern Daylight Time	07/30/2015 11:26:38 AM Eastern Daylight Time			08/04/2015 01:19:58 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-005 (HMO)	01	01		1			H1951	005	0	2016	Baton Rouge Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	013	0	1	01	01	H1951_013_0	4		1	07/08/2015	2016.01	07/08/2015 03:06:18 PM Eastern Daylight Time	08/03/2015 01:49:14 PM Eastern Daylight Time	07/29/2015 09:53:20 PM Eastern Daylight Time			08/04/2015 01:19:58 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-013 (HMO)	01	01		1			H1951	013	0	2016	Shreveport Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4		1	07/08/2015	2016.01	07/08/2015 03:06:31 PM Eastern Daylight Time	08/03/2015 02:06:23 PM Eastern Daylight Time	07/30/2015 11:27:16 AM Eastern Daylight Time			08/04/2015 01:19:58 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-024 (HMO)	01	01		1			H1951	024	0	2016	Tangipahoa Parish		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	025	0	1	01	01	H1951_025_0	4		1	07/08/2015	2016.01	07/08/2015 03:06:51 PM Eastern Daylight Time	08/03/2015 02:09:45 PM Eastern Daylight Time	07/29/2015 09:54:30 PM Eastern Daylight Time			08/04/2015 01:19:58 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-025 (HMO)	01	01		1			H1951	025	0	2016	Select Louisiana Parishes		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4		1	07/07/2015	2016.01	07/07/2015 04:16:27 PM Eastern Daylight Time	08/03/2015 02:11:15 PM Eastern Daylight Time	07/30/2015 11:27:52 AM Eastern Daylight Time			08/04/2015 01:19:58 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-028 (HMO)	01	01		1			H1951	028	0	2016	Washington and St. Tammany Parishes		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	030	0	1	01	01	H1951_030_0	3		1	07/08/2015	2016.01	07/08/2015 03:07:11 PM Eastern Daylight Time	05/24/2015 04:57:09 PM Eastern Daylight Time				07/10/2015 11:56:20 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-030 (HMO)	01	01		1			H1951	030	0	2016	Baton Rouge Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1951	032	0	1	01	01	H1951_032_0	5	2	1	07/31/2015	2016.01	07/31/2015 01:46:02 PM Eastern Daylight Time	08/03/2015 02:16:57 PM Eastern Daylight Time	07/30/2015 11:28:28 AM Eastern Daylight Time			08/04/2015 01:19:58 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1951-032 (HMO SNP)	01	01		1			H1951	032	0	2016	Baton Rouge Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	033	0	1	01	01	H1951_033_0	5	2	1	07/31/2015	2016.01	07/31/2015 01:48:42 PM Eastern Daylight Time	08/03/2015 02:15:40 PM Eastern Daylight Time	07/30/2015 11:29:04 AM Eastern Daylight Time			08/04/2015 01:19:58 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1951-033 (HMO SNP)	01	01		1			H1951	033	0	2016	New Orleans Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	5	2	1	07/31/2015	2016.01	07/31/2015 01:51:03 PM Eastern Daylight Time	08/03/2015 02:14:20 PM Eastern Daylight Time	07/30/2015 11:29:40 AM Eastern Daylight Time			08/04/2015 01:29:29 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1951-034 (HMO SNP)	01	01		1			H1951	034	0	2016	Washington and St. Tammany Parishes		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	036	0	1	01	01	H1951_036_0	4		1	07/14/2015	2016.01	07/14/2015 10:19:31 AM Eastern Daylight Time	08/03/2015 02:25:19 PM Eastern Daylight Time	07/30/2015 11:30:16 AM Eastern Daylight Time			08/04/2015 01:29:29 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1951	036	0	2016	New Orleans Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	037	0	1	01	01	H1951_037_0	4		1	07/14/2015	2016.01	07/14/2015 10:20:05 AM Eastern Daylight Time	08/03/2015 02:18:17 PM Eastern Daylight Time	07/29/2015 09:58:04 PM Eastern Daylight Time			08/04/2015 01:29:29 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1951	037	0	2016	Shreveport Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 03:08:40 PM Eastern Daylight Time	08/03/2015 02:23:54 PM Eastern Daylight Time	07/30/2015 11:30:52 AM Eastern Daylight Time			08/04/2015 01:29:29 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Total Care Advantage H1951-038 (HMO)	01	01		1			H1951	038	0	2016	New Orleans Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	039	0	1	01	01	H1951_039_0	3		1	07/08/2015	2016.01	07/08/2015 03:08:49 PM Eastern Daylight Time	08/03/2015 02:22:36 PM Eastern Daylight Time	07/30/2015 11:31:28 AM Eastern Daylight Time			08/04/2015 01:29:29 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Total Care Advantage H1951-039 (HMO)	01	01		1			H1951	039	0	2016	Baton Rouge Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	07/20/2015	2016.01	07/20/2015 04:00:08 PM Eastern Daylight Time	08/03/2015 02:39:58 PM Eastern Daylight Time	07/29/2015 09:59:50 PM Eastern Daylight Time			08/04/2015 01:29:29 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1951-041 (HMO SNP)	01	01		1			H1951	041	0	2016	Select Louisiana Parishes		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	042	0	1	01	01	H1951_042_0	3		1	07/07/2015	2016.01	07/07/2015 04:18:34 PM Eastern Daylight Time	08/03/2015 02:31:32 PM Eastern Daylight Time	07/29/2015 10:00:24 PM Eastern Daylight Time			08/04/2015 01:29:29 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-042 (HMO)	01	01		1			H1951	042	0	2016	Louisiana Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	043	0	1	01	01	H1951_043_0	4		1	07/14/2015	2016.01	07/14/2015 10:20:43 AM Eastern Daylight Time	08/03/2015 02:29:45 PM Eastern Daylight Time	07/29/2015 10:01:00 PM Eastern Daylight Time			08/04/2015 01:29:29 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes (HMO SNP)	01	01		1			H1951	043	0	2016	East Baton Rouge Parish		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	044	0	1	01	01	H1951_044_0	4		1	07/14/2015	2016.01	07/14/2015 10:20:53 AM Eastern Daylight Time	08/03/2015 02:37:10 PM Eastern Daylight Time	07/30/2015 11:32:04 AM Eastern Daylight Time			08/04/2015 01:29:29 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H1951	044	0	2016	Jefferson and Orleans Parishes		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/11/2015	2016.01	05/11/2015 02:05:33 PM Eastern Daylight Time	05/29/2015 08:09:44 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1951	801	0	2016	Select parishes in Louisiana		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1951	804	0	1	01	01	H1951_804_0	1		1	05/11/2015	2016.01	05/11/2015 02:06:38 PM Eastern Daylight Time	05/29/2015 08:16:00 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1951	804	0	2016	Select parishes in Louisiana		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H1961	002	0	1	01	01	H1961_002_0	8		1	08/05/2015	2016.01	08/05/2015 03:59:52 PM Central Daylight Time	08/05/2015 03:54:39 PM Central Daylight Time	08/05/2015 03:47:12 PM Central Daylight Time			08/05/2015 05:46:58 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Plus (HMO)	01	01		1			H1961	002	0	2016	Southeast Louisiana		2	5990	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	003	0	1	01	01	H1961_003_0	7	2	1	08/05/2015	2016.01	08/05/2015 04:48:41 PM Central Daylight Time	08/05/2015 03:55:46 PM Central Daylight Time	08/05/2015 03:48:10 PM Central Daylight Time			08/05/2015 05:46:58 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Health (HMO SNP)	01	01		1			H1961	003	0	2016	New Orleans Metro and Southeast Louisiana		2	15000	2			1	3		1	2			www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	007	0	1	01	01	H1961_007_0	7		1	07/23/2015	2016.01	07/23/2015 12:26:48 PM Central Daylight Time	08/05/2015 03:57:07 PM Central Daylight Time	08/05/2015 03:49:04 PM Central Daylight Time			08/05/2015 05:46:58 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Select (HMO)	01	01		1			H1961	007	0	2016	Southeast Louisiana		2	1500	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	009	0	1	01	01	H1961_009_0	7		1	07/23/2015	2016.01	07/23/2015 12:26:38 PM Central Daylight Time	08/05/2015 03:58:47 PM Central Daylight Time	08/05/2015 03:50:40 PM Central Daylight Time			08/05/2015 05:46:58 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Platinum #009 (HMO)	01	01		1			H1961	009	0	2016	Orleans, Jefferson Parish		2	7000	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	010	0	1	01	01	H1961_010_0	5	2	1	08/05/2015	2016.01	08/05/2015 05:38:47 PM Central Daylight Time	08/05/2015 03:59:52 PM Central Daylight Time	08/05/2015 03:51:22 PM Central Daylight Time			08/05/2015 05:46:58 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Choice #010 (HMO SNP)	01	01		1			H1961	010	0	2016	Southwest Louisiana		2	100	2			1	3		1	2			www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	011	0	1	01	01	H1961_011_0	5	2	1	08/05/2015	2016.01	08/05/2015 05:40:30 PM Central Daylight Time	08/05/2015 04:01:30 PM Central Daylight Time	08/05/2015 03:52:04 PM Central Daylight Time			08/05/2015 05:46:58 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Choice #011 (HMO SNP)	01	01		1			H1961	011	0	2016	North and Central Louisiana		2	100	2			1	3		1	2			www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	014	1	1	01	01	H1961_014_1	7		1	07/23/2015	2016.01	07/23/2015 12:26:28 PM Central Daylight Time	08/05/2015 04:02:36 PM Central Daylight Time	08/05/2015 03:52:48 PM Central Daylight Time			08/05/2015 05:46:58 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 #14 (HMO)	01	01		1			H1961	014	1	2016	Metro New Orleans Area	Metro New Orleans Area	2	20000	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	014	2	1	01	01	H1961_014_2	6		1	07/23/2015	2016.01	07/23/2015 12:26:16 PM Central Daylight Time	08/05/2015 04:03:46 PM Central Daylight Time	08/05/2015 03:53:31 PM Central Daylight Time			08/05/2015 05:46:58 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 #14 (HMO)	01	01		1			H1961	014	2	2016	Metro New Orleans Area	St. Tammany Parish	2	6500	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	801	0	1	02	01	H1961_801_0	4		1	06/01/2015	2016.01	06/01/2015 01:34:06 PM Central Daylight Time	05/30/2015 05:50:01 PM Central Daylight Time				06/01/2015 03:03:20 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	801	0	2016	Nationwide		1	2500	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	802	0	1	02	01	H1961_802_0	4		1	06/01/2015	2016.01	06/01/2015 01:35:57 PM Central Daylight Time	05/30/2015 05:52:28 PM Central Daylight Time				06/01/2015 03:03:20 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	802	0	2016	Nationwide		1	2500	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	803	0	1	01	01	H1961_803_0	4		1	06/01/2015	2016.01	06/01/2015 01:36:12 PM Central Daylight Time	05/30/2015 05:55:28 PM Central Daylight Time				06/01/2015 03:03:20 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	803	0	2016	Nationwide		1	650	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1961	804	0	1	01	01	H1961_804_0	3		1	05/26/2015	2016.01	05/26/2015 12:45:53 PM Central Daylight Time	05/30/2015 05:58:25 PM Central Daylight Time				05/30/2015 07:25:23 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	804	0	2016	Nationwide		1	650	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2	2			
H1969	002	0	1	01	01	H1969_002_0	7		1	08/04/2015	2016.01	08/04/2015 12:28:19 PM Mountain Daylight Time	08/04/2015 02:48:12 PM Mountain Daylight Time	08/05/2015 04:24:06 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO (HMO)	01	01		1			H1969	002	0	2016	Ada and Canyon Counties		2	1460	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1969	003	0	1	01	01	H1969_003_0	7		1	08/04/2015	2016.01	08/04/2015 12:28:41 PM Mountain Daylight Time	08/04/2015 02:48:54 PM Mountain Daylight Time	08/05/2015 04:24:25 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO Plus (HMO)	01	01		1			H1969	003	0	2016	Ada and Canyon Counties		2	234	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1977	001	0	1	48	05	H1977_001_0	4		1	08/28/2015	2016.01	08/28/2015 10:11:59 AM Eastern Daylight Time					08/28/2015 10:13:19 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	2016	Upper Peninsula of Michigan		2	5000	2			2							www.uphp.com/medicare	http://www.uphp.com/medicare	http://www.uphp.com/medicare	(877)349-9324		(906)225-4481		(877)349-9324		(906)225-4481		(855)380-0275		(855)380-0275		(855)380-0275		(855)380-0275		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(711)-		(711)-		(711)-		(711)-		2					2					2				
H1994	001	0	1	01	01	H1994_001_0	5		1	07/01/2015	2016.01	07/01/2015 10:01:40 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time			08/05/2015 09:16:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	001	0	2016	Counties: Dav, Mor, SLC, Sum, Uta, Was, Web		2	18771	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2	2			
H1994	002	0	1	01	01	H1994_002_0	5		1	07/01/2015	2016.01	07/01/2015 10:01:59 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time			08/05/2015 09:16:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	002	0	2016	Garfield, Iron, Sanpete, Sevier, and Washington Co		2	5839	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(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	5		1	07/01/2015	2016.01	07/01/2015 10:02:23 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time			08/05/2015 09:16:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	003	0	2016	Counties: Ada, Adams, Boi, Can, Elm, Gem, Owy, Was		2	8534	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(208)429-9900		(855)442-9940		(855)442-9940		(855)442-9900		(208)429-9900		(855)442-9940		(855)442-9940		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		2					2					2	2			
H1994	004	0	1	01	01	H1994_004_0	5		1	07/01/2015	2016.01	07/01/2015 10:04:49 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time			08/05/2015 09:16:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	004	0	2016	Twin Falls, Cassia, Minidoka, and Jerome Counties		2	3089	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		2					2					2	2			
H1994	005	0	1	01	01	H1994_005_0	5		1	07/02/2015	2016.01	07/02/2015 01:13:09 PM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time			08/05/2015 09:16:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	005	0	2016	Box Elder, Cache, Franklin, and Rich Counties		2	819	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(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	006	0	1	01	01	H1994_006_0	5		1	07/02/2015	2016.01	07/02/2015 01:13:30 PM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time	08/05/2015 09:13:06 AM Mountain Daylight Time			08/05/2015 09:16:51 AM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	006	0	2016	Bingham, Blaine, and Bonneville Counties		2	275	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(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	801	0	1	01	01	H1994_801_0	1		1	05/31/2015	2016.01	05/31/2015 04:36:54 PM Mountain Daylight Time	05/31/2015 08:52:20 PM Mountain Daylight Time				05/31/2015 08:59:21 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	801	0	2016	Utah and Idaho		1	300	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(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	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;15;16b;	2		1					1	2			
H1994	802	0	1	01	01	H1994_802_0	1		1	05/31/2015	2016.01	05/31/2015 04:47:24 PM Mountain Daylight Time	05/31/2015 08:52:20 PM Mountain Daylight Time				05/31/2015 08:59:21 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	802	0	2016	Utah and Idaho		1	300	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;15;16b;	2		1					1	2			
H1994	803	0	1	01	01	H1994_803_0	1		1	05/31/2015	2016.01	05/31/2015 04:47:34 PM Mountain Daylight Time	05/31/2015 08:52:20 PM Mountain Daylight Time				05/31/2015 08:59:21 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO)	01	01		1			H1994	803	0	2016	Utah and Idaho		1	300	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(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	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;15;16b;	2		1					1	2			
H1997	002	0	1	01	01	H1997_002_0	7		1	08/04/2015	2016.01	08/04/2015 10:59:26 AM Mountain Daylight Time	08/04/2015 02:49:36 PM Mountain Daylight Time	08/05/2015 04:24:44 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H1997	002	0	2016	King, Pierce and Snohomish counties		2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2001	001	0	1	04	01	H2001_001_0	2		1	07/31/2015	2016.01	07/31/2015 02:02:22 PM Central Daylight Time	07/31/2015 12:25:06 PM Central Daylight Time	07/30/2015 07:59:50 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H2001	001	0	2016	Select counties in Maine		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	010	0	1	04	01	H2001_010_0	2		1	07/31/2015	2016.01	07/31/2015 02:02:06 PM Central Daylight Time	07/31/2015 12:25:30 PM Central Daylight Time	07/30/2015 08:00:40 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H2001	010	0	2016	Select counties in Maine		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2001	816	0	1	04	01	H2001_816_0	1		1	05/11/2015	2016.01	05/11/2015 11:38:08 AM Central Daylight Time	05/29/2015 04:06:19 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	816	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	817	0	1	04	01	H2001_817_0	1		1	04/16/2015	2016.01	04/16/2015 08:29:44 AM Central Daylight Time	05/29/2015 04:06:58 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	817	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H2001	818	0	1	04	01	H2001_818_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:34 PM Central Daylight Time	05/29/2015 04:07:36 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	818	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	819	0	2	04	01	H2001_819_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:35 PM Central Daylight Time	05/29/2015 04:08:15 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	819	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	820	0	2	04	01	H2001_820_0	1		1	04/16/2015	2016.01	04/16/2015 08:29:11 AM Central Daylight Time	05/29/2015 04:08:53 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	820	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H2001	821	0	2	04	01	H2001_821_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:38 PM Central Daylight Time	05/29/2015 04:09:32 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	821	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	822	0	1	04	01	H2001_822_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:39 PM Central Daylight Time	05/29/2015 04:10:05 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	822	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	823	0	1	04	01	H2001_823_0	1		1	04/16/2015	2016.01	04/16/2015 08:29:50 AM Central Daylight Time	05/29/2015 04:10:40 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	823	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H2001	824	0	1	04	01	H2001_824_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:42 PM Central Daylight Time	05/29/2015 04:11:14 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	824	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	825	0	1	04	01	H2001_825_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:43 PM Central Daylight Time	05/29/2015 04:11:47 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	825	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	826	0	1	04	01	H2001_826_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:44 PM Central Daylight Time	05/29/2015 04:12:20 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	826	0	2016	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	827	0	1	04	01	H2001_827_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:45 PM Central Daylight Time	05/29/2015 04:12:58 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	827	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	828	0	1	04	01	H2001_828_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:46 PM Central Daylight Time	05/29/2015 04:13:38 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	828	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	829	0	1	04	01	H2001_829_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:47 PM Central Daylight Time	05/29/2015 04:14:15 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	829	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	830	0	1	04	01	H2001_830_0	1		1	04/16/2015	2016.01	04/16/2015 08:29:55 AM Central Daylight Time	05/29/2015 04:14:54 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	830	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H2001	831	0	1	04	01	H2001_831_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:50 PM Central Daylight Time	05/29/2015 04:15:33 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	831	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	832	0	2	04	01	H2001_832_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:51 PM Central Daylight Time	05/29/2015 04:16:13 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	832	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2001	833	0	2	04	01	H2001_833_0	1		1	04/16/2015	2016.01	04/16/2015 08:30:00 AM Central Daylight Time	05/29/2015 04:16:53 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	833	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
H2001	834	0	2	04	01	H2001_834_0	1		1	04/13/2015	2016.01	04/13/2015 01:20:54 PM Central Daylight Time	05/29/2015 04:17:33 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	834	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2012	002	0	1	01	01	H2012_002_0	3		1	07/08/2015	2016.01	07/08/2015 02:44:54 PM Eastern Daylight Time	08/01/2015 09:55:31 AM Eastern Daylight Time	07/29/2015 10:02:12 PM Eastern Daylight Time			08/04/2015 01:51:17 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-002 (HMO)	01	01		1			H2012	002	0	2016	Birmingham Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	003	0	1	01	01	H2012_003_0	3		1	07/08/2015	2016.01	07/08/2015 02:51:59 PM Eastern Daylight Time	08/01/2015 09:55:51 AM Eastern Daylight Time	07/29/2015 10:02:46 PM Eastern Daylight Time			08/04/2015 01:51:17 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-003 (HMO)	01	01		1			H2012	003	0	2016	Mobile Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	006	0	1	01	01	H2012_006_0	3		1	07/08/2015	2016.01	07/08/2015 09:35:19 AM Eastern Daylight Time	07/31/2015 04:00:05 PM Eastern Daylight Time	07/29/2015 10:03:22 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-006 (HMO)	01	01		1			H2012	006	0	2016	Richland County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	008	0	1	01	01	H2012_008_0	3		1	07/08/2015	2016.01	07/08/2015 02:22:49 PM Eastern Daylight Time	07/31/2015 05:59:14 PM Eastern Daylight Time	07/30/2015 11:32:42 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-008 (HMO)	01	01		1			H2012	008	0	2016	Richmond Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	009	0	1	01	01	H2012_009_0	3		1	07/08/2015	2016.01	07/08/2015 02:51:43 PM Eastern Daylight Time	07/31/2015 05:43:53 PM Eastern Daylight Time	07/30/2015 11:33:18 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-009 (HMO)	01	01		1			H2012	009	0	2016	Indianapolis Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	011	0	1	01	01	H2012_011_0	3		1	07/07/2015	2016.01	07/07/2015 04:08:50 PM Eastern Daylight Time	07/31/2015 05:14:55 PM Eastern Daylight Time	07/29/2015 10:05:08 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-011 (HMO)	01	01		1			H2012	011	0	2016	Lexington Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	012	0	1	01	01	H2012_012_0	3		1	07/07/2015	2016.01	07/07/2015 04:09:14 PM Eastern Daylight Time	07/31/2015 05:14:35 PM Eastern Daylight Time	07/29/2015 10:05:44 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-012 (HMO)	01	01		1			H2012	012	0	2016	Louisville Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	015	0	1	01	01	H2012_015_0	3		1	07/08/2015	2016.01	07/08/2015 10:04:17 AM Eastern Daylight Time	08/01/2015 09:56:52 AM Eastern Daylight Time	07/30/2015 11:33:54 AM Eastern Daylight Time			08/04/2015 01:51:17 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-015 (HMO)	01	01		1			H2012	015	0	2016	Select VA Counties in the Tri-Cities Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	016	0	1	01	01	H2012_016_0	4		1	07/08/2015	2016.01	07/08/2015 02:57:12 PM Eastern Daylight Time	08/01/2015 09:57:33 AM Eastern Daylight Time	07/30/2015 11:34:30 AM Eastern Daylight Time			08/04/2015 01:51:17 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-016 (HMO)	01	01		1			H2012	016	0	2016	Select VA Counties in the Tri-Cities Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	021	0	1	01	01	H2012_021_0	3		1	07/08/2015	2016.01	07/08/2015 12:53:59 PM Eastern Daylight Time	08/04/2015 10:46:06 AM Eastern Daylight Time	07/29/2015 10:07:30 PM Eastern Daylight Time			08/04/2015 01:11:35 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-021 (HMO)	01	01		1			H2012	021	0	2016	Omaha Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	022	0	1	01	01	H2012_022_0	3		1	07/20/2015	2016.01	07/20/2015 12:40:20 PM Eastern Daylight Time	08/03/2015 11:17:22 AM Eastern Daylight Time	07/29/2015 10:08:04 PM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-022 (HMO)	01	01		1			H2012	022	0	2016	Ada, Canyon and Payette counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	027	0	1	01	01	H2012_027_0	3		1	07/08/2015	2016.01	07/08/2015 02:52:07 PM Eastern Daylight Time	07/31/2015 05:50:06 PM Eastern Daylight Time	07/30/2015 11:35:06 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-027 (HMO)	01	01		1			H2012	027	0	2016	Evansville Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	028	0	1	01	01	H2012_028_0	3		1	07/08/2015	2016.01	07/08/2015 02:52:27 PM Eastern Daylight Time	07/31/2015 05:49:26 PM Eastern Daylight Time	07/29/2015 10:09:16 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-028 (HMO)	01	01		1			H2012	028	0	2016	Fort Wayne Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	029	0	1	01	01	H2012_029_0	3		1	07/08/2015	2016.01	07/08/2015 02:23:35 PM Eastern Daylight Time	07/31/2015 06:04:35 PM Eastern Daylight Time	07/30/2015 11:35:42 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-029 (HMO)	01	01		1			H2012	029	0	2016	Tidewater area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	030	0	1	01	01	H2012_030_0	4		1	07/08/2015	2016.01	07/08/2015 12:32:55 PM Eastern Daylight Time	08/03/2015 11:18:01 AM Eastern Daylight Time	07/29/2015 10:10:26 PM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-030 (HMO)	01	01		1			H2012	030	0	2016	Bonner, Boundary and Kootenai counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	031	0	1	01	01	H2012_031_0	3		1	07/07/2015	2016.01	07/07/2015 03:54:15 PM Eastern Daylight Time	08/03/2015 11:18:40 AM Eastern Daylight Time	07/29/2015 10:11:02 PM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-031 (HMO)	01	01		1			H2012	031	0	2016	Clark County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	033	0	1	01	01	H2012_033_0	4		1	07/08/2015	2016.01	07/08/2015 01:24:16 PM Eastern Daylight Time	08/03/2015 11:23:12 AM Eastern Daylight Time	07/30/2015 11:36:18 AM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Community HMO (HMO)	01	01		1			H2012	033	0	2016	King County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	035	0	1	01	01	H2012_035_0	3		1	07/07/2015	2016.01	07/07/2015 03:55:35 PM Eastern Daylight Time	08/03/2015 11:19:17 AM Eastern Daylight Time	07/30/2015 11:36:54 AM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-035 (HMO)	01	01		1			H2012	035	0	2016	Pierce County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	037	0	1	01	01	H2012_037_0	3		1	07/08/2015	2016.01	07/08/2015 12:31:37 PM Eastern Daylight Time	08/03/2015 11:19:55 AM Eastern Daylight Time	07/30/2015 11:37:32 AM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-037 (HMO)	01	01		1			H2012	037	0	2016	Snohomish County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	039	0	1	01	01	H2012_039_0	3		1	07/08/2015	2016.01	07/08/2015 12:58:49 PM Eastern Daylight Time	08/03/2015 11:20:32 AM Eastern Daylight Time	07/30/2015 11:38:08 AM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Community HMO (HMO)	01	01		1			H2012	039	0	2016	Spokane County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	042	0	1	01	01	H2012_042_0	4	2	1	07/14/2015	2016.01	07/14/2015 10:17:44 AM Eastern Daylight Time	08/01/2015 12:57:29 PM Eastern Daylight Time	07/30/2015 11:38:44 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-042 (HMO SNP)	01	01		1			H2012	042	0	2016	Richmond-Tidewater area		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	053	0	1	01	01	H2012_053_0	4	2	1	07/31/2015	2016.01	07/31/2015 12:54:31 PM Eastern Daylight Time	07/31/2015 10:59:18 AM Eastern Daylight Time	07/29/2015 10:14:36 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-053 (HMO SNP)	01	01		1			H2012	053	0	2016	Greater South Carolina		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	054	0	1	01	01	H2012_054_0	4	2	1	07/08/2015	2016.01	07/08/2015 04:05:29 PM Eastern Daylight Time	08/02/2015 10:25:12 AM Eastern Daylight Time	07/30/2015 11:39:20 AM Eastern Daylight Time			08/04/2015 01:51:17 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-054 (HMO SNP)	01	01		1			H2012	054	0	2016	Select Counties in Virginia		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	055	0	1	01	01	H2012_055_0	3		1	07/08/2015	2016.01	07/08/2015 09:14:28 AM Eastern Daylight Time	07/31/2015 06:05:39 PM Eastern Daylight Time	07/29/2015 10:15:46 PM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-055 (HMO)	01	01		1			H2012	055	0	2016	Charlottesville Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	056	0	1	01	01	H2012_056_0	3		1	07/08/2015	2016.01	07/08/2015 02:52:45 PM Eastern Daylight Time	08/02/2015 10:51:54 AM Eastern Daylight Time	07/29/2015 10:16:22 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-056 (HMO)	01	01		1			H2012	056	0	2016	Marshall and St. Joseph counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	060	0	1	01	01	H2012_060_0	4		1	07/14/2015	2016.01	07/14/2015 10:17:51 AM Eastern Daylight Time	07/31/2015 06:06:11 PM Eastern Daylight Time	07/30/2015 11:39:56 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H2012	060	0	2016	Richmond - Tidewater area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	064	0	1	01	01	H2012_064_0	4	2	1	07/31/2015	2016.01	07/31/2015 01:46:38 PM Eastern Daylight Time	07/31/2015 05:54:48 PM Eastern Daylight Time	07/30/2015 11:40:32 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-064 (HMO SNP)	01	01		1			H2012	064	0	2016	Central Indiana Area		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	070	0	1	01	01	H2012_070_0	3	2	1	07/31/2015	2016.01	07/31/2015 09:31:31 AM Eastern Daylight Time	08/03/2015 12:34:01 PM Eastern Daylight Time	07/29/2015 10:18:08 PM Eastern Daylight Time			08/04/2015 01:51:17 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-070 (HMO SNP)	01	01		1			H2012	070	0	2016	Greater Alabama		2		2			1	3		1	2			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	080	0	1	01	01	H2012_080_0	3		1	07/08/2015	2016.01	07/08/2015 02:58:12 PM Eastern Daylight Time	08/03/2015 11:05:29 AM Eastern Daylight Time	07/29/2015 10:18:44 PM Eastern Daylight Time			08/04/2015 01:30:38 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-080 (HMO)	01	01		1			H2012	080	0	2016	Select Counties in Arkansas		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	082	0	1	01	01	H2012_082_0	3		1	07/09/2015	2016.01	07/09/2015 01:43:07 PM Eastern Daylight Time	08/03/2015 11:06:33 AM Eastern Daylight Time	07/29/2015 10:19:20 PM Eastern Daylight Time			08/04/2015 01:30:38 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-082 (HMO)	01	01		1			H2012	082	0	2016	Select Counties in Arkansas		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	084	0	1	01	01	H2012_084_0	4		1	07/14/2015	2016.01	07/14/2015 10:34:04 AM Eastern Daylight Time	07/31/2015 05:58:00 PM Eastern Daylight Time	07/30/2015 11:41:10 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H2012	084	0	2016	Indianapolis Metro Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	087	0	1	01	01	H2012_087_0	3		1	07/08/2015	2016.01	07/08/2015 11:14:03 AM Eastern Daylight Time	07/31/2015 06:08:14 PM Eastern Daylight Time	07/29/2015 10:20:30 PM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-087 (HMO)	01	01		1			H2012	087	0	2016	Northern Virginia area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	088	0	1	01	01	H2012_088_0	3		1	07/07/2015	2016.01	07/07/2015 03:57:37 PM Eastern Daylight Time	08/03/2015 11:26:22 AM Eastern Daylight Time	07/29/2015 10:21:06 PM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-088 (HMO)	01	01		1			H2012	088	0	2016	King, Pierce, Clark and Snohomish counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	090	0	1	01	01	H2012_090_0	3		1	07/08/2015	2016.01	07/08/2015 12:37:00 PM Eastern Daylight Time	08/03/2015 11:26:59 AM Eastern Daylight Time	07/29/2015 10:21:42 PM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-090 (HMO)	01	01		1			H2012	090	0	2016	Thurston and Lewis counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	093	0	1	01	01	H2012_093_0	3		1	07/07/2015	2016.01	07/07/2015 04:07:47 PM Eastern Daylight Time	08/03/2015 11:24:24 AM Eastern Daylight Time	07/29/2015 10:22:18 PM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-093 (HMO)	01	01		1			H2012	093	0	2016	Benton, Franklin, Spokane and Yakima counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	095	0	1	01	01	H2012_095_0	3	2	1	07/07/2015	2016.01	07/07/2015 03:58:14 PM Eastern Daylight Time	08/03/2015 11:25:04 AM Eastern Daylight Time	07/30/2015 11:41:46 AM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-095 (HMO SNP)	01	01		1			H2012	095	0	2016	Select Counties in Washington		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	096	0	1	01	01	H2012_096_0	3		1	07/08/2015	2016.01	07/08/2015 09:35:43 AM Eastern Daylight Time	07/31/2015 04:02:50 PM Eastern Daylight Time	07/29/2015 10:23:30 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-096 (HMO)	01	01		1			H2012	096	0	2016	Charleston Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	097	0	1	01	01	H2012_097_0	4		1	07/08/2015	2016.01	07/08/2015 03:02:51 PM Eastern Daylight Time	08/01/2015 09:59:38 AM Eastern Daylight Time	07/29/2015 10:24:04 PM Eastern Daylight Time			08/04/2015 01:51:17 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-097 (HMO)	01	01		1			H2012	097	0	2016	Madison and Limestone counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	099	1	1	01	01	H2012_099_1	3		1	07/08/2015	2016.01	07/08/2015 08:19:17 AM Eastern Daylight Time	08/03/2015 11:12:36 AM Eastern Daylight Time	07/30/2015 11:42:22 AM Eastern Daylight Time			08/04/2015 01:30:38 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-099 (HMO)	01	01		1			H2012	099	1	2016	Select Counties in Arkansas	Select Counties in Arkansas	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	099	2	1	01	01	H2012_099_2	3		1	07/08/2015	2016.01	07/08/2015 08:26:19 AM Eastern Daylight Time	08/03/2015 11:13:42 AM Eastern Daylight Time	07/30/2015 11:42:58 AM Eastern Daylight Time			08/04/2015 01:30:38 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-099 (HMO)	01	01		1			H2012	099	2	2016	Select Counties in Arkansas	Select Counties in Arkansas	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	100	4	1	01	01	H2012_100_4	4		1	07/08/2015	2016.01	07/08/2015 09:35:57 AM Eastern Daylight Time	08/01/2015 06:42:09 PM Eastern Daylight Time	07/29/2015 10:25:52 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-100 (HMO)	01	01		1			H2012	100	4	2016	Spartanburg/Greenville Metro Area	Spartanburg Metro Area	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	100	5	1	01	01	H2012_100_5	4		1	07/08/2015	2016.01	07/08/2015 09:36:09 AM Eastern Daylight Time	08/01/2015 07:09:42 PM Eastern Daylight Time	07/29/2015 10:26:26 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-100 (HMO)	01	01		1			H2012	100	5	2016	Spartanburg/Greenville Metro Area	Greenville Metro Area	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	101	1	1	01	01	H2012_101_1	3		1	07/10/2015	2016.01	07/10/2015 01:10:58 PM Eastern Daylight Time	07/31/2015 06:14:16 PM Eastern Daylight Time	07/29/2015 10:27:02 PM Eastern Daylight Time			08/04/2015 01:46:58 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-101 (HMO)	01	01		1			H2012	101	1	2016	Roanoke Metro Area	Roanoke Metro Area	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	101	2	1	01	01	H2012_101_2	3		1	07/10/2015	2016.01	07/10/2015 01:11:19 PM Eastern Daylight Time	07/31/2015 06:14:50 PM Eastern Daylight Time	07/29/2015 10:27:38 PM Eastern Daylight Time			08/04/2015 01:46:58 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-101 (HMO)	01	01		1			H2012	101	2	2016	Roanoke Metro Area	Roanoke Metro Area	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	102	0	1	01	01	H2012_102_0	3		1	07/08/2015	2016.01	07/08/2015 02:53:32 PM Eastern Daylight Time	07/31/2015 06:01:57 PM Eastern Daylight Time	07/30/2015 11:43:34 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-102 (HMO)	01	01		1			H2012	102	0	2016	Lake county		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	103	0	1	01	01	H2012_103_0	3	2	1	07/31/2015	2016.01	07/31/2015 01:42:15 PM Eastern Daylight Time	08/01/2015 01:02:10 PM Eastern Daylight Time	07/29/2015 10:28:48 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-103 (HMO SNP)	01	01		1			H2012	103	0	2016	Central Kentucky area		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	104	0	1	01	01	H2012_104_0	3	2	1	07/31/2015	2016.01	07/31/2015 01:44:52 PM Eastern Daylight Time	08/01/2015 01:43:29 PM Eastern Daylight Time	07/29/2015 10:29:24 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-104 (HMO SNP)	01	01		1			H2012	104	0	2016	Clark and Floyd counties		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2012	801	0	1	01	01	H2012_801_0	3		1	05/11/2015	2016.01	05/11/2015 02:07:41 PM Eastern Daylight Time	05/29/2015 08:12:04 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2012	801	0	2016	Multi-State		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2012	802	0	1	01	01	H2012_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:08:44 PM Eastern Daylight Time	05/29/2015 08:13:41 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2012	802	0	2016	Multi-State		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2029	001	0	1	04	01	H2029_001_0	4		1	07/15/2015	2016.01	07/15/2015 02:06:16 PM Eastern Daylight Time	08/04/2015 10:48:23 AM Eastern Daylight Time	07/29/2015 10:30:00 PM Eastern Daylight Time			08/04/2015 01:21:43 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	HumanaChoice Value H2029-001 (PPO)	01	04		1			H2029	001	0	2016	Puerto Rico Island Wide		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2029	801	0	1	04	01	H2029_801_0	1		1	05/18/2015	2016.01	05/18/2015 10:12:22 AM Eastern Daylight Time	05/29/2015 10:58:11 AM Eastern Daylight Time				05/29/2015 11:27:21 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H2029	801	0	2016	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H2029	802	0	1	04	01	H2029_802_0	1		1	05/13/2015	2016.01	05/13/2015 12:39:45 PM Eastern Daylight Time	05/29/2015 11:01:45 AM Eastern Daylight Time				05/29/2015 11:27:21 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H2029	802	0	2016	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H2029	803	0	1	04	01	H2029_803_0	2		1	05/12/2015	2016.01	05/13/2015 11:35:04 AM Eastern Daylight Time	05/29/2015 04:13:30 PM Eastern Daylight Time				05/29/2015 04:47:07 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H2029	803	0	2016	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H2029	805	0	2	04	01	H2029_805_0	2		1	05/18/2015	2016.01	05/18/2015 09:43:40 AM Eastern Daylight Time	05/29/2015 04:13:58 PM Eastern Daylight Time				05/29/2015 04:47:07 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H2029	805	0	2016	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H2029	806	0	2	04	01	H2029_806_0	2		1	05/14/2015	2016.01	05/14/2015 08:10:55 AM Eastern Daylight Time	05/29/2015 04:14:28 PM Eastern Daylight Time				05/29/2015 04:47:07 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H2029	806	0	2016	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H2029	807	0	2	04	01	H2029_807_0	2		1	05/13/2015	2016.01	05/13/2015 03:51:02 PM Eastern Daylight Time	05/29/2015 04:14:56 PM Eastern Daylight Time				05/29/2015 04:47:07 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H2029	807	0	2016	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H2034	001	0	1	01	01	H2034_001_0	7	2	1	08/11/2015	2016.01	08/11/2015 03:11:07 PM Central Daylight Time	08/11/2015 11:26:25 AM Central Daylight Time	08/05/2015 03:39:28 PM Central Daylight Time			08/12/2015 11:57:16 AM Central Daylight Time	COMMUNITY CARE HEALTH PLAN, INC.	Community Care	www.communitycareinc.org	Community Care's  Partnership Program (HMO SNP)	01	01		1			H2034	001	0	2016	Eastern Wisconsin		2	283	2			1	3		1	5			www.communitycareinc.org	www.communitycareinc.org	www.communitycareinc.org	(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H2034	002	0	1	01	01	H2034_002_0	6	2	1	08/11/2015	2016.01	08/11/2015 03:11:22 PM Central Daylight Time	08/11/2015 11:27:45 AM Central Daylight Time	08/05/2015 03:39:37 PM Central Daylight Time			08/12/2015 11:57:16 AM Central Daylight Time	COMMUNITY CARE HEALTH PLAN, INC.	Community Care	www.communitycareinc.org	Community Care's Partnership Program Disabled (HMO SNP)	01	01		1			H2034	002	0	2016	Eastern Wisconsin		2	283	2			1	3		1	5			www.communitycareinc.org	www.communitycareinc.org	www.communitycareinc.org	(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H2064	001	0	1	20	08	H2064_001_0	1		1	06/01/2015	2016.01	06/01/2015 12:11:37 PM Eastern Daylight Time		06/01/2015 10:21:20 AM Eastern Daylight Time			06/01/2015 12:23:59 PM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	001	0	2016	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	1		1	06/01/2015	2016.01	06/01/2015 12:11:30 PM Eastern Daylight Time		06/01/2015 10:22:11 AM Eastern Daylight Time			06/01/2015 12:23:59 PM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	002	0	2016	LIFE Geisinger		2		2			2								www.lifegeisinger.org	www.lifegeisinger.org									(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790										(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790																
H2108	001	0	1	01	01	H2108_001_0	5	2	1	07/14/2015	2016.01	07/14/2015 04:14:07 PM Central Daylight Time	07/31/2015 01:48:04 PM Central Daylight Time	07/30/2015 08:12:08 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H2108	001	0	2016	Maryland, Washington DC and Delaware Counties		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	020	0	1	01	01	H2108_020_0	4		1	07/31/2015	2016.01	07/31/2015 07:49:39 AM Central Daylight Time	07/31/2015 01:48:33 PM Central Daylight Time	07/30/2015 08:12:40 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Traditions (HMO SNP)	01	01		1			H2108	020	0	2016	Maryland, Washington DC, and Delaware Counties		2		2			1	1	1	1				www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	022	0	1	01	01	H2108_022_0	4		1	07/14/2015	2016.01	07/14/2015 04:16:52 PM Central Daylight Time	07/31/2015 01:49:03 PM Central Daylight Time	07/30/2015 08:13:09 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H2108	022	0	2016	Select Maryland Counties		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	028	0	1	01	01	H2108_028_0	4		1	07/14/2015	2016.01	07/14/2015 04:17:21 PM Central Daylight Time	07/31/2015 01:49:31 PM Central Daylight Time	07/30/2015 08:13:38 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H2108	028	0	2016	Maryland, Washington DC and Delaware Counties		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	029	0	1	01	01	H2108_029_0	4		1	07/14/2015	2016.01	07/14/2015 04:17:37 PM Central Daylight Time	07/31/2015 01:50:00 PM Central Daylight Time	07/30/2015 08:14:08 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Achieve (HMO SNP)	01	01		1			H2108	029	0	2016	Maryland, Washington DC and Delaware Counties		2		2			1	4		1		00000010000000000000		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	030	0	1	01	01	H2108_030_0	5		1	07/14/2015	2016.01	07/14/2015 04:18:04 PM Central Daylight Time	07/31/2015 01:50:31 PM Central Daylight Time	07/30/2015 08:14:37 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Achieve (HMO SNP)	01	01		1			H2108	030	0	2016	Select Maryland Counties		2		2			1	4		1		00000010000000000000		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	032	0	1	01	01	H2108_032_0	4		1	07/14/2015	2016.01	07/14/2015 04:18:23 PM Central Daylight Time	07/31/2015 01:51:00 PM Central Daylight Time	07/30/2015 08:15:08 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreventiveCare (HMO)	01	01		1			H2108	032	0	2016	Maryland, Washington DC, and Delaware Counties		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	033	0	1	01	01	H2108_033_0	4		1	07/14/2015	2016.01	07/14/2015 04:18:37 PM Central Daylight Time	07/31/2015 01:51:29 PM Central Daylight Time	07/30/2015 08:15:38 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreventiveCare (HMO)	01	01		1			H2108	033	0	2016	Select Maryland Counties		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2108	801	0	1	01	01	H2108_801_0	4		1	05/08/2015	2016.01	05/08/2015 06:47:58 PM Eastern Daylight Time	07/10/2015 10:02:17 PM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H2108	801	0	2016	Statewide MD, DC and DE		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;7f;12;	1					1	2			
H2108	802	0	1	02	01	H2108_802_0	5		1	05/28/2015	2016.01	05/28/2015 12:03:51 PM Eastern Daylight Time	07/12/2015 09:23:10 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H2108	802	0	2016	Statewide MD, DC and DE		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;7f;12;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7d;7f;12;	1	2			
H2108	803	0	1	01	01	H2108_803_0	4		1	05/08/2015	2016.01	05/08/2015 06:47:49 PM Eastern Daylight Time	07/12/2015 09:23:40 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H2108	803	0	2016	Statewide MD, DC and DE		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;7f;12;	1					1	2			
H2108	804	0	1	01	01	H2108_804_0	4		1	05/08/2015	2016.01	05/08/2015 06:47:37 PM Eastern Daylight Time	07/12/2015 09:24:10 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H2108	804	0	2016	Statewide MD, DC and DE		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;7f;12;	1					1	2			
H2108	805	0	1	02	01	H2108_805_0	5		1	05/28/2015	2016.01	05/28/2015 12:00:22 PM Eastern Daylight Time	07/12/2015 09:24:40 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H2108	805	0	2016	Statewide MD, DC and DE		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;7f;12;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7d;7f;12;	1	2			
H2108	806	0	1	02	01	H2108_806_0	5		1	05/28/2015	2016.01	05/28/2015 11:46:19 AM Eastern Daylight Time	07/12/2015 09:25:10 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H2108	806	0	2016	Statewide MD, DC and DE		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(877)357-1685		(877)357-1685		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;7f;12;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7d;7f;12;	1	2			
H2109	001	0	1	20	08	H2109_001_0	3		1	05/18/2015	2016.01	05/18/2015 09:38:22 AM Eastern Daylight Time		05/15/2015 03:48:14 PM Eastern Daylight Time			05/18/2015 12:02:27 PM Eastern Daylight Time	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	Hopkins ElderPlus	http://www.hopkinsbayview.org/hopkinselderplus	The Johns Hopkins Health System Corporation. (PACE)	08	20		1			H2109	001	0	2016	Parts of Baltimore City and County, Maryland		2		2			2								http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus									(800)550-7044		(410)550-7044		(410)550-7044		(410)550-7044										(800)735-2258		(410)550-0316		(800)735-2258		(410)550-0316																
H2109	002	0	1	20	08	H2109_002_0	2		1	05/18/2015	2016.01	05/18/2015 09:38:47 AM Eastern Daylight Time		05/15/2015 03:49:30 PM Eastern Daylight Time			05/18/2015 10:03:35 AM Eastern Daylight Time	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	Hopkins ElderPlus	http://www.hopkinsbayview.org/hopkinselderplus	The Johns Hopkins Health System Corporation (PACE)	08	20		1			H2109	002	0	2016	Parts of Baltimore City and County, Maryland		2		2			2								http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus									(800)550-7044		(410)550-7044		(410)550-7044		(410)550-7044										(800)735-2258		(410)550-0316		(800)735-2258		(410)550-0316																
H2150	002	0	1	18	06	H2150_002_0	5		1	07/29/2015	2016.01	07/29/2015 09:33:28 PM Eastern Daylight Time		07/29/2015 05:48:06 PM Eastern Daylight Time			08/02/2015 08:31:00 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus High w/Part D (AB) (Cost)	06	18		1			H2150	002	0	2016	DC, MD, VA		2	15701	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	009	0	1	18	06	H2150_009_0	5		1	07/29/2015	2016.01	07/29/2015 09:33:53 PM Eastern Daylight Time		07/29/2015 05:54:24 PM Eastern Daylight Time			08/02/2015 08:31:00 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost)	06	18		1			H2150	009	0	2016	DC, MD, VA		2	26638	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	017	0	1	18	06	H2150_017_0	3		1	06/29/2015	2016.01	06/29/2015 04:36:59 PM Eastern Daylight Time					07/10/2015 04:57:26 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/o D (AB) (Cost)	06	18		1			H2150	017	0	2016	DC, MD, VA		2	1540	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	021	0	1	18	06	H2150_021_0	3		1	06/29/2015	2016.01	06/29/2015 04:35:05 PM Eastern Daylight Time					07/10/2015 04:57:26 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus High w/o D (AB) (Cost)	06	18		1			H2150	021	0	2016	DC, MD, VA		2	497	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	022	0	1	18	06	H2150_022_0	3		1	06/29/2015	2016.01	06/29/2015 04:35:45 PM Eastern Daylight Time					07/10/2015 04:57:26 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Std w/o D (AB) (Cost)	06	18		1			H2150	022	0	2016	DC, MD, VA		2	1790	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	029	0	2	18	06	H2150_029_0	5		1	07/29/2015	2016.01	07/29/2015 09:34:31 PM Eastern Daylight Time		07/29/2015 05:57:48 PM Eastern Daylight Time			08/02/2015 08:31:00 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Std w/Part D (B) (Cost)	06	18		2	1		H2150	029	0	2016	DC, MD, VA		2	47	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	030	0	2	18	06	H2150_030_0	2		1	05/18/2015	2016.01	05/18/2015 05:23:56 PM Eastern Daylight Time					05/30/2015 11:46:28 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/o D (B) (Cost)	06	18		2	1		H2150	030	0	2016	DC, MD, VA		2	3	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	033	0	1	18	06	H2150_033_0	3		1	07/29/2015	2016.01	07/29/2015 09:34:49 PM Eastern Daylight Time		07/29/2015 06:02:34 PM Eastern Daylight Time			08/02/2015 08:31:00 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/D (AB) (Cost)	06	18		1			H2150	033	0	2016	DC, MD, VA		2	199	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	034	0	2	18	06	H2150_034_0	3		1	07/29/2015	2016.01	07/29/2015 09:35:22 PM Eastern Daylight Time		07/29/2015 06:07:47 PM Eastern Daylight Time			08/02/2015 08:31:00 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/D (B) (Cost)	06	18		2	1		H2150	034	0	2016	DC, MD, VA		2	1	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2150	801	0	1	18	06	H2150_801_0	2		1	05/08/2015	2016.01	05/08/2015 03:03:16 PM Eastern Daylight Time					05/30/2015 11:46:28 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus GRP w/Part D (AB) (Cost)	06	18		1			H2150	801	0	2016	DC, MD, VA		1	11732	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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			
H2150	805	0	2	18	06	H2150_805_0	2		1	05/08/2015	2016.01	05/08/2015 03:03:31 PM Eastern Daylight Time					05/30/2015 11:46:28 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus GRP w/Part D (B) (Cost)	06	18		2	1		H2150	805	0	2016	DC, MD, VA		1	1	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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			
H2150	806	0	1	18	06	H2150_806_0	2		1	05/08/2015	2016.01	05/08/2015 03:03:38 PM Eastern Daylight Time					05/30/2015 11:46:28 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus FED w/Part D (AB) (Cost)	06	18		1			H2150	806	0	2016	DC, MD, VA		1	11680	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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			
H2150	807	0	2	18	06	H2150_807_0	2		1	05/08/2015	2016.01	05/08/2015 03:03:44 PM Eastern Daylight Time					05/30/2015 11:46:28 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus FED w/Part D (B) (Cost)	06	18		2	1		H2150	807	0	2016	DC, MD, VA		1	180	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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			
H2161	001	0	1	01	01	H2161_001_0	6	2	1	08/04/2015	2016.01	08/04/2015 02:04:59 PM Eastern Daylight Time	08/05/2015 05:18:27 PM Eastern Daylight Time	08/05/2015 05:18:27 PM Eastern Daylight Time			08/05/2015 05:30:03 PM Eastern Daylight Time	UPPER PENINSULA HEALTH PLAN, LLC	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan Plus (HMO SNP)	01	01		1			H2161	001	0	2016	Upper Peninsula of Michigan		2	100	2			1	3		1	4			www.uphp.com/medicare	uphp.com/medicare	uphp.com/medicare	(877)349-9324		(906)225-4481		(877)349-9324		(906)225-4481		(844)827-0182		(844)827-0182		(844)827-0182		(844)827-0182		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2161	002	0	1	01	01	H2161_002_0	3		1	07/10/2015	2016.01	07/10/2015 02:29:03 PM Eastern Daylight Time	08/05/2015 05:18:27 PM Eastern Daylight Time	08/05/2015 05:18:27 PM Eastern Daylight Time			08/05/2015 05:32:43 PM Eastern Daylight Time	UPPER PENINSULA HEALTH PLAN, LLC	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan Advantage (HMO)	01	01		1			H2161	002	0	2016	Upper Peninsula of Michigan		2		2			2							www.uphp.com/medicare	uphp.com/medicare	uphp.com/medicare	(877)349-9324		(906)225-4481		(877)349-9324		(906)225-4481		(844)827-0182		(844)827-0182		(844)827-0182		(844)827-0182		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2165	005	0	1	01	01	H2165_005_0	4		1	07/14/2015	2016.01	07/14/2015 04:27:40 PM Central Daylight Time	07/31/2015 07:43:48 PM Central Daylight Time	07/30/2015 08:16:07 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred NGA (HMO)	01	01		1			H2165	005	0	2016	Northwest Georgia		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2165	018	0	1	01	01	H2165_018_0	4		1	07/09/2015	2016.01	07/09/2015 03:24:16 PM Central Daylight Time	07/31/2015 09:07:55 AM Central Daylight Time	07/30/2015 08:16:37 AM Central Daylight Time			08/03/2015 09:24:52 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H2165	018	0	2016	North Texas		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2165	019	0	1	01	01	H2165_019_0	4	2	1	07/31/2015	2016.01	07/31/2015 07:41:07 AM Central Daylight Time	07/31/2015 09:08:27 AM Central Daylight Time	07/30/2015 08:17:09 AM Central Daylight Time			08/03/2015 09:24:52 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H2165	019	0	2016	North Texas		2		2			1	3		1	4			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2165	804	0	1	01	01	H2165_804_0	3		1	05/22/2015	2016.01	05/22/2015 08:24:52 AM Central Daylight Time	07/10/2015 10:02:50 PM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H2165	804	0	2016	Nationwide		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H2165	806	0	1	02	01	H2165_806_0	3		1	05/22/2015	2016.01	05/22/2015 08:38:29 AM Central Daylight Time	07/12/2015 09:27:12 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H2165	806	0	2016	Nationwide		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;	1	2			
H2165	807	0	1	01	01	H2165_807_0	3		1	05/22/2015	2016.01	05/22/2015 08:24:41 AM Central Daylight Time	07/12/2015 09:27:46 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H2165	807	0	2016	Nationwide		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;14d;14e;18a;	1					1	2			
H2165	808	0	1	01	01	H2165_808_0	3		1	05/22/2015	2016.01	05/22/2015 08:26:28 AM Central Daylight Time	07/12/2015 09:28:22 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H2165	808	0	2016	Nationwide		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H2165	809	0	1	02	01	H2165_809_0	3		1	05/22/2015	2016.01	05/22/2015 08:40:38 AM Central Daylight Time	07/12/2015 09:28:56 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H2165	809	0	2016	Nationwide		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;	1	2			
H2165	810	0	1	02	01	H2165_810_0	3		1	05/22/2015	2016.01	05/22/2015 08:43:01 AM Central Daylight Time	07/12/2015 09:29:31 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H2165	810	0	2016	Nationwide		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;	1	2			
H2171	001	0	1	01	01	H2171_001_0	6		1	08/05/2015	2016.01	08/05/2015 05:09:14 PM Eastern Daylight Time	08/05/2015 06:13:08 PM Eastern Daylight Time	08/04/2015 02:31:26 PM Eastern Daylight Time			08/05/2015 07:02:35 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan I (HMO)	01	01		1			H2171	001	0	2016	Dallas Fort Worth Metro Area		2	500	2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2171	801	0	1	01	01	H2171_801_0	7		1	05/31/2015	2016.01	05/31/2015 11:48:58 PM Eastern Daylight Time	07/03/2015 01:43:32 AM Eastern Daylight Time				07/17/2015 01:30:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Emp-only Care N' Care Health Plan Employer Group (HMO)	01	01		1			H2171	801	0	2016	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H2171	802	0	1	01	01	H2171_802_0	7		1	04/28/2015	2016.01	04/28/2015 01:29:41 PM Eastern Daylight Time	07/03/2015 01:39:30 AM Eastern Daylight Time				07/17/2015 01:30:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Emp-only Care N' Care Health Plan Employer Group (HMO)	01	01		1			H2171	802	0	2016	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H2171	803	0	1	01	01	H2171_803_0	7		1	05/27/2015	2016.01	05/27/2015 12:43:03 PM Eastern Daylight Time	07/03/2015 01:32:05 AM Eastern Daylight Time				07/17/2015 01:30:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Emp-only Care N' Care Health Plan Employer Group (HMO)	01	01		1			H2171	803	0	2016	Nationwide		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)-										1	2		2		1					1	2			
H2171	804	0	1	01	01	H2171_804_0	7		1	04/28/2015	2016.01	04/28/2015 01:31:17 PM Eastern Daylight Time	07/03/2015 01:27:33 AM Eastern Daylight Time				07/17/2015 01:30:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Emp-only Care N' Care Health Plan Employer Group (HMO)	01	01		1			H2171	804	0	2016	Nationwide		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)-										1	2		2		1					1	2			
H2174	001	0	1	01	01	H2174_001_0	6	2	1	08/05/2015	2016.01	08/05/2015 05:14:30 PM Pacific Daylight Time	08/05/2015 01:27:54 PM Pacific Daylight Time	08/05/2015 10:50:16 AM Pacific Daylight Time			08/05/2015 07:59:14 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage Dual (HMO SNP)	01	01		1			H2174	001	0	2016	Lane County		2	4545	2			1	3		1	3		2	www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					2	2			
H2174	003	0	1	01	01	H2174_003_0	6		1	08/05/2015	2016.01	08/05/2015 05:25:55 PM Pacific Daylight Time	08/05/2015 01:28:42 PM Pacific Daylight Time	08/05/2015 10:50:26 AM Pacific Daylight Time			08/05/2015 07:59:14 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage TLC ISNP (HMO SNP)	01	01		1			H2174	003	0	2016	Lane County		2	51	2			1	1	1	1				www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					2	2			
H2174	005	0	1	01	01	H2174_005_0	6		1	08/05/2015	2016.01	08/05/2015 05:26:17 PM Pacific Daylight Time	08/05/2015 01:30:22 PM Pacific Daylight Time	08/05/2015 10:50:36 AM Pacific Daylight Time			08/05/2015 07:59:14 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage TLC Community ISNP (HMO SNP)	01	01		1			H2174	005	0	2016	Lane County		2	108	2			1	1	2	1				www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					2	2			
H2174	009	0	1	01	01	H2174_009_0	5		1	08/05/2015	2016.01	08/05/2015 05:26:26 PM Pacific Daylight Time	08/05/2015 12:15:52 PM Pacific Daylight Time	08/05/2015 10:50:48 AM Pacific Daylight Time			08/05/2015 07:59:14 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage Focus Rx (HMO)	01	01		1			H2174	009	0	2016	Lane County		2	23	2			2							www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					2	2			
H2218	001	0	1	20	08	H2218_001_0	2		1	06/01/2015	2016.01	06/01/2015 02:01:36 PM Eastern Daylight Time		06/01/2015 12:02:18 PM Eastern Daylight Time			06/01/2015 02:05:53 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	2016	Norfolk and Suffolk Counties		2		2			2								www.elderserviceplan.org	www.eatonapothecary.com									(866)714-1277		(617)533-2400		(866)714-1277		(617)533-2400										(866)714-1277		(617)533-2400		(866)714-1277		(617)533-2400																
H2218	002	0	1	20	08	H2218_002_0	2		1	06/01/2015	2016.01	06/01/2015 02:02:47 PM Eastern Daylight Time		06/01/2015 12:11:33 PM Eastern Daylight Time			06/01/2015 02:05:53 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	2016	Norfolk and Suffolk Counties		2		2			2								www.elderserviceplan.org	www.eatonapothecary.com									(866)714-1277		(617)533-2400		(866)714-1277		(617)533-2400										(866)714-1277		(617)533-2400		(866)714-1277		(617)533-2400																
H2219	001	0	1	20	08	H2219_001_0	1		1	05/08/2015	2016.01	05/08/2015 01:09:41 PM Eastern Daylight Time		05/29/2015 10:57:06 AM Eastern Daylight Time			05/30/2015 06:11:02 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Summit ElderCare or Fallon Health	www.summiteldercare.org	Summit ElderCare (PACE)	08	20		1			H2219	001	0	2016	Full: Worc, Hampden, Partial: Hampshire, Middlesex		2	918	2			2								Not Applicable	Not Applicable									(800)698-7566		(508)852-2026		(800)698-7566		(508)368-9690										(800)439-2370		(800)439-2370		(800)889-4106		(800)889-4106																
H2219	002	0	1	20	08	H2219_002_0	1		1	05/08/2015	2016.01	05/08/2015 01:10:28 PM Eastern Daylight Time		05/29/2015 11:03:41 AM Eastern Daylight Time			05/30/2015 06:11:02 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Summit ElderCare or Fallon Health	www.summiteldercare.org	Summit ElderCare (PACE)	08	20		1			H2219	002	0	2016	Full: Worc, Hampden, Partial: Hampshire, Middlesex		2	5	2			2								Not Applicable	Not Applicable									(800)698-7566		(508)852-2026		(800)698-7566		(508)368-9690										(800)439-2370		(800)439-2370		(800)889-4106		(800)889-4106																
H2220	001	0	1	20	08	H2220_001_0	1		1	05/20/2015	2016.01	05/20/2015 01:10:00 PM Eastern Daylight Time		05/18/2015 10:03:33 AM Eastern Daylight Time			05/20/2015 01:12:38 PM Eastern Daylight Time	UPHAMS CORNER HEALTH COMMITTEE, INC.	Uphams Corner Health Committee, Inc.	www.uphamselderserviceplan.org	Uphams Corner Health Committee (PACE)	08	20		1			H2220	001	0	2016	Upham's Elder Service Plan		2		2			2								http://www.uphamscornerhealthctr.com/	http://www.uphamscornerhealthctr.com/									(617)288-0970	8803	(617)288-0970	8803	(617)288-0970	8803	(617)288-0970	8803									(617)287-8000	8206	(617)287-8000	8206	(617)287-8000	8206	(617)287-8000	8206															
H2220	002	0	1	20	08	H2220_002_0	1		1	05/20/2015	2016.01	05/20/2015 01:10:25 PM Eastern Daylight Time		05/18/2015 10:03:28 AM Eastern Daylight Time			05/20/2015 01:12:38 PM Eastern Daylight Time	UPHAMS CORNER HEALTH COMMITTEE, INC.	Uphams Corner Health Committee, Inc.	www.uphamselderserviceplan.org	Uphams Corner Health Committee (PACE)	08	20		1			H2220	002	0	2016	Upham's Elder Service Plan		2		2			2								http://www.uphamscornerhealthctr.com/	http://www.uphamscornerhealthctr.com/									(617)288-0970	8803	(617)288-0970	8803	(617)288-0970	8820	(617)288-0970	8820									(617)287-8000	8206	(617)287-8000	8206	(617)287-8000	8206	(617)287-8000	8206															
H2221	001	0	1	20	08	H2221_001_0	1		1	05/27/2015	2016.01	05/27/2015 02:13:18 PM Eastern Daylight Time		05/26/2015 02:28:40 PM Eastern Daylight Time			05/27/2015 02:16:34 PM Eastern Daylight Time	ELDER SVC PLAN OF THE CAMBRIDGE HEALTH ALLIANCE	Elder Srvc Pln/Cambridge Health Alliance	Challiance.org	Elder Service Plan of the Cambridge Health (PACE)	08	20		1			H2221	001	0	2016	Counties: Middlesex and Suffolk		2	3500	2			2								none	none									(617)575-5850		(617)575-5850		(617)575-5850		(617)575-5850										(617)575-5850		(617)575-5850		(617)575-5850		(617)575-5850																
H2221	002	0	1	20	08	H2221_002_0	1		1	05/27/2015	2016.01	05/27/2015 02:14:06 PM Eastern Daylight Time		05/26/2015 02:29:52 PM Eastern Daylight Time			05/27/2015 02:16:34 PM Eastern Daylight Time	ELDER SVC PLAN OF THE CAMBRIDGE HEALTH ALLIANCE	Elder Srvc Pln/Cambridge Health Alliance	Challiance.org	Elder Service Plan of the Cambridge Health (PACE)	08	20		1			H2221	002	0	2016	Counties:  Middlesex and Suffolk		2		2			2								none	none									(617)575-5850		(617)575-5850		(617)575-5850		(617)575-5850										(617)575-5850		(617)575-5850		(617)575-5850		(617)575-5850																
H2222	002	0	1	20	08	H2222_002_0	1		1	05/21/2015	2016.01	05/21/2015 01:13:48 PM Eastern Daylight Time		05/18/2015 11:44:47 AM Eastern Daylight Time			05/21/2015 01:16:31 PM Eastern Daylight Time	ELEMENT CARE, INC.	Element Care, Inc	www.elementcare.org	Element Care (PACE)	08	20		1			H2222	002	0	2016	Essex, Middlesex counties		2		2			2								None	www.eatonapothecary.com									(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650									(781)715-6608		(781)715-6608		(781)715-6608		(781)715-6608	6688															
H2222	003	0	1	20	08	H2222_003_0	1		1	05/21/2015	2016.01	05/21/2015 01:14:30 PM Eastern Daylight Time		05/15/2015 05:36:49 PM Eastern Daylight Time			05/21/2015 01:16:31 PM Eastern Daylight Time	ELEMENT CARE, INC.	Element Care, Inc	www.elementcare.org	Element Care (PACE)	08	20		1			H2222	003	0	2016	Essex, Middlesex counties		2		2			2								None	www.eatonapothecary.com									(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650									(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650															
H2223	001	0	1	20	08	H2223_001_0	1		1	05/20/2015	2016.01	05/20/2015 01:09:58 PM Eastern Daylight Time		05/18/2015 02:24:51 PM Eastern Daylight Time			05/20/2015 01:12:27 PM Eastern Daylight Time	ELDER SVC PLN/E BOSTON HEALTH CENTER	Elder Svc Pln/E Boston Health Center	www.ebnhc.org	East Boston Elder Service Plan (PACE)	08	20		1			H2223	001	0	2016	Chelsea, Revere, East Boston, Everett, Winthrop MA		2		2			2								www.ebnhc.org	www.ebnhc.org									(617)568-4733		(617)568-4733		(617)568-4733		(617)568-4733										(800)720-3480		(800)720-3480		(800)720-3480		(800)720-3480																
H2223	002	0	1	20	08	H2223_002_0	1		1	05/20/2015	2016.01	05/20/2015 01:10:17 PM Eastern Daylight Time		05/18/2015 02:33:55 PM Eastern Daylight Time			05/20/2015 01:12:27 PM Eastern Daylight Time	ELDER SVC PLN/E BOSTON HEALTH CENTER	Elder Svc Pln/E Boston Health Center	www.ebnhc.org	East Boston Elder Service Plan (PACE)	08	20		1			H2223	002	0	2016	Chelsea, Revere, East Boston, Everett, Winthrop MA		2		2			2								www.ebnhc.org	www.ebnhc.org									(617)568-4733		(617)568-4733		(617)568-4733		(617)568-4733										(800)720-3480		(800)720-3480		(800)720-3480		(800)720-3480																
H2224	001	0	1	01	01	H2224_001_0	5	2	1	07/08/2015	2016.01	07/08/2015 10:40:59 AM Eastern Daylight Time	07/30/2015 03:23:44 PM Eastern Daylight Time	07/30/2015 03:27:54 PM Eastern Daylight Time			08/04/2015 02:32:26 PM Eastern Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.seniorwholehealth.com	Senior Whole Health (HMO SNP)	01	01		1			H2224	001	0	2016	Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor		2	7519	2			1	3		1	5			www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2224	003	0	1	01	01	H2224_003_0	5	2	1	07/08/2015	2016.01	07/08/2015 10:42:15 AM Eastern Daylight Time	08/04/2015 01:53:17 PM Eastern Daylight Time	08/04/2015 01:53:20 PM Eastern Daylight Time			08/04/2015 02:32:26 PM Eastern Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.seniorwholehealth.com	Senior Whole Health NHC (HMO SNP)	01	01		1			H2224	003	0	2016	Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor		2	4400	2			1	3		1	5			www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2225	001	0	1	01	01	H2225_001_0	3	2	1	05/26/2015	2016.01	05/26/2015 04:31:33 PM Eastern Daylight Time	07/31/2015 05:07:05 PM Eastern Daylight Time	07/31/2015 12:52:11 PM Eastern Daylight Time			08/03/2015 04:13:07 PM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance, Inc.	www.commonwealthcaresco.org	Senior Care Options Program (HMO SNP)	01	01		1			H2225	001	0	2016	BRI, ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR		2		2			1	3		1	5			www.commonwealthcare.org	www.commonwealthcaresco.org/pharmacy-program/formulary	www.commonwealthcaresco.org/pharmacy-program/overview	(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7e;7f;7h;9b;10a;11a;11b;16b;	2		2					1	2			
H2226	001	0	1	01	01	H2226_001_0	3	2	1	05/26/2015	2016.01	05/26/2015 08:32:54 AM Central Daylight Time	07/31/2015 01:11:50 PM Central Daylight Time	07/30/2015 08:01:41 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Senior Care Options (HMO SNP)	01	01		1			H2226	001	0	2016	Boston, Springfield and Worcester Metro Areas		2		2			1	3		1	5			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(888)867-5511		(888)867-5511		(800)555-5757		(800)555-5757		(888)867-5511		(888)867-5511		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2228	001	0	1	04	01	H2228_001_0	3		1	06/16/2015	2016.01	06/16/2015 03:31:33 PM Central Daylight Time	07/31/2015 01:02:46 PM Central Daylight Time	07/30/2015 08:11:36 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2228	001	0	2016	Select Counties in Massachusetts		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	002	0	1	04	01	H2228_002_0	3		1	07/31/2015	2016.01	07/31/2015 09:30:27 AM Central Daylight Time	07/31/2015 01:03:11 PM Central Daylight Time	07/30/2015 08:12:37 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2228	002	0	2016	State of Rhode Island		2		2			1	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	4		1	07/31/2015	2016.01	07/31/2015 09:30:57 AM Central Daylight Time	07/31/2015 01:03:37 PM Central Daylight Time	07/30/2015 08:13:31 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2228	010	0	2016	Select Counties in Delaware, Maryland and Virginia		2		2			1	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	05/29/2015	2016.01	05/29/2015 06:10:16 PM Central Daylight Time	07/31/2015 01:04:02 PM Central Daylight Time	07/30/2015 08:14:15 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H2228	011	0	2016	Select Counties in Maryland		2		2			1	1	2	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	012	0	1	04	01	H2228_012_0	2		1	05/29/2015	2016.01	05/29/2015 06:10:29 PM Central Daylight Time	07/31/2015 01:04:28 PM Central Daylight Time	07/30/2015 08:14:59 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H2228	012	0	2016	Kent and New Castle counties		2		2			1	1	2	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	013	0	1	04	01	H2228_013_0	4		1	07/31/2015	2016.01	07/31/2015 09:31:28 AM Central Daylight Time	07/31/2015 01:04:54 PM Central Daylight Time	07/30/2015 08:15:55 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2228	013	0	2016	Select Counties in Georgia		2		2			1	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	015	0	1	04	01	H2228_015_0	4		1	05/28/2015	2016.01	05/28/2015 02:17:32 PM Central Daylight Time	07/31/2015 01:05:19 PM Central Daylight Time	07/30/2015 08:16:54 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2228	015	0	2016	Bernalillo County		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	016	0	1	04	01	H2228_016_0	3		1	05/28/2015	2016.01	05/28/2015 02:17:46 PM Central Daylight Time	07/31/2015 01:05:46 PM Central Daylight Time	07/30/2015 08:17:55 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2228	016	0	2016	Select Counties in Oregon		2		2			1	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	05/29/2015	2016.01	05/29/2015 06:10:47 PM Central Daylight Time	07/31/2015 01:06:12 PM Central Daylight Time	07/30/2015 08:18:42 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H2228	017	0	2016	Select Counties in Oregon		2		2			1	1	2	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	018	0	1	04	01	H2228_018_0	2		1	07/31/2015	2016.01	07/31/2015 02:03:54 PM Central Daylight Time	07/31/2015 01:06:38 PM Central Daylight Time	07/30/2015 08:19:29 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	018	0	2016	Select counties in North 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			
H2228	019	0	1	04	01	H2228_019_0	5		1	08/03/2015	2016.01	08/03/2015 09:48:31 AM Central Daylight Time	07/31/2015 01:07:04 PM Central Daylight Time	07/30/2015 08:20:17 AM Central Daylight Time			08/03/2015 04:36:58 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	019	0	2016	Northern Indiana		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	020	0	1	04	01	H2228_020_0	2		1	07/31/2015	2016.01	07/31/2015 09:25:20 AM Central Daylight Time	07/31/2015 01:07:30 PM Central Daylight Time	07/30/2015 08:21:00 AM Central Daylight Time			08/03/2015 04:36:58 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (PPO)	01	04		1			H2228	020	0	2016	Fort Wayne area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	021	0	1	04	01	H2228_021_0	4		1	07/31/2015	2016.01	07/31/2015 09:25:53 AM Central Daylight Time	07/31/2015 01:07:57 PM Central Daylight Time	07/30/2015 08:21:45 AM Central Daylight Time			08/03/2015 04:36:58 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	021	0	2016	Indianapolis area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	022	0	1	04	01	H2228_022_0	2		1	07/31/2015	2016.01	07/31/2015 09:27:02 AM Central Daylight Time	07/31/2015 01:08:23 PM Central Daylight Time	07/30/2015 08:22:32 AM Central Daylight Time			08/03/2015 04:36:58 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	022	0	2016	Evansville area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	023	0	1	04	01	H2228_023_0	2		1	07/31/2015	2016.01	07/31/2015 09:27:30 AM Central Daylight Time	07/31/2015 01:08:50 PM Central Daylight Time	07/30/2015 08:23:18 AM Central Daylight Time			08/03/2015 04:36:58 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	023	0	2016	El Paso area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	024	0	1	04	01	H2228_024_0	2		1	07/31/2015	2016.01	07/31/2015 11:39:10 AM Central Daylight Time	07/31/2015 01:09:15 PM Central Daylight Time	07/30/2015 08:24:03 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H2228	024	0	2016	Honolulu County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	025	0	1	04	01	H2228_025_0	1		1	05/30/2015	2016.01	05/30/2015 02:36:31 PM Central Daylight Time	05/29/2015 05:28:20 PM Central Daylight Time				06/01/2015 03:10:36 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Essential (PPO)	01	04		1			H2228	025	0	2016	Honolulu County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	029	0	1	04	01	H2228_029_0	2		1	07/31/2015	2016.01	07/31/2015 12:28:35 PM Central Daylight Time	07/31/2015 01:09:41 PM Central Daylight Time	07/30/2015 08:24:47 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	029	0	2016	Portland Metro Area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	030	0	1	04	01	H2228_030_0	2		1	07/31/2015	2016.01	07/31/2015 09:27:48 AM Central Daylight Time	07/31/2015 01:10:07 PM Central Daylight Time	07/30/2015 08:25:31 AM Central Daylight Time			08/03/2015 04:36:58 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	030	0	2016	Select counties in Illinois and Missouri		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	031	0	1	04	01	H2228_031_0	2		1	07/31/2015	2016.01	07/31/2015 09:36:04 AM Central Daylight Time	07/31/2015 01:10:33 PM Central Daylight Time	07/30/2015 08:26:16 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	031	0	2016	Ada and Canyon 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			
H2228	032	0	1	04	01	H2228_032_0	2		1	07/31/2015	2016.01	07/31/2015 09:49:13 AM Central Daylight Time	07/31/2015 01:10:59 PM Central Daylight Time	07/30/2015 08:27:01 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H2228	032	0	2016	Ada and Canyon 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			
H2228	033	0	1	04	01	H2228_033_0	2		1	07/31/2015	2016.01	07/31/2015 02:05:45 PM Central Daylight Time	07/31/2015 01:11:25 PM Central Daylight Time	07/30/2015 08:27:49 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	033	0	2016	Tampa Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	034	0	1	04	01	H2228_034_0	2		1	07/31/2015	2016.01	07/31/2015 02:07:35 PM Central Daylight Time	07/31/2015 01:11:52 PM Central Daylight Time	07/30/2015 08:28:36 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	034	0	2016	Lancaster and York counties		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			
H2228	035	0	1	04	01	H2228_035_0	2		1	07/31/2015	2016.01	07/31/2015 02:13:25 PM Central Daylight Time	07/31/2015 01:12:17 PM Central Daylight Time	07/30/2015 08:29:21 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H2228	035	0	2016	Erie, Lehigh and Northampton		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			
H2228	036	0	1	04	01	H2228_036_0	2		1	07/31/2015	2016.01	07/31/2015 02:16:10 PM Central Daylight Time	07/31/2015 01:12:43 PM Central Daylight Time	07/30/2015 08:30:07 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H2228	036	0	2016	Erie, Lehigh and Northampton counties		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			
H2228	037	0	1	04	01	H2228_037_0	2		1	07/31/2015	2016.01	07/31/2015 02:17:27 PM Central Daylight Time	07/31/2015 01:13:09 PM Central Daylight Time	07/30/2015 08:30:54 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2228	037	0	2016	Chester and Philadelphia counties		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			
H2228	039	0	1	04	01	H2228_039_0	3		1	06/16/2015	2016.01	06/16/2015 03:35:29 PM Central Daylight Time	07/31/2015 01:13:37 PM Central Daylight Time	07/30/2015 08:31:40 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO SNP)	01	04		1			H2228	039	0	2016	State of Rhode Island		2		2			1	1	2	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	041	0	1	04	01	H2228_041_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:31:52 AM Central Daylight Time	07/31/2015 01:14:03 PM Central Daylight Time	07/30/2015 08:32:39 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	041	0	2016	El Paso County		2		2			1	3		1	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			
H2228	042	0	1	04	01	H2228_042_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:32:26 AM Central Daylight Time	07/31/2015 01:14:29 PM Central Daylight Time	07/30/2015 08:33:38 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	042	0	2016	Dona Ana, Grant, Hidalgo, Luna and Sierra counties		2		2			1	3		1	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			
H2228	043	0	1	04	01	H2228_043_0	3	2	1	06/01/2015	2016.01	06/01/2015 11:48:16 AM Central Daylight Time	07/31/2015 01:14:57 PM Central Daylight Time	07/30/2015 08:34:37 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	043	0	2016	Honolulu County		2		2			1	3		1	5			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			
H2228	044	0	1	04	01	H2228_044_0	3	2	1	06/01/2015	2016.01	06/01/2015 11:48:55 AM Central Daylight Time	07/31/2015 01:15:23 PM Central Daylight Time	07/30/2015 08:35:36 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	044	0	2016	Atlanta and Macon Metro Areas		2		2			1	3		1	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			
H2228	045	0	1	04	01	H2228_045_0	3	2	1	06/01/2015	2016.01	06/01/2015 12:18:28 PM Central Daylight Time	07/31/2015 01:15:49 PM Central Daylight Time	07/30/2015 08:36:34 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	045	0	2016	Washington, DC		2		2			1	3		1	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			
H2228	046	0	1	04	01	H2228_046_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:32:57 AM Central Daylight Time	07/31/2015 01:16:14 PM Central Daylight Time	07/30/2015 08:37:33 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2228	046	0	2016	Bernalillo, Sandoval, Santa Fe, Valencia Counties		2		2			1	3		1	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			
H2228	805	0	1	04	01	H2228_805_0	1		1	04/13/2015	2016.01	04/23/2015 02:32:05 PM Central Daylight Time	05/29/2015 05:37:06 PM Central Daylight Time				06/01/2015 02:01:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2228	805	0	2016	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2230	002	0	1	04	01	H2230_002_0	5		1	07/17/2015	2016.01	07/17/2015 11:50:30 AM Eastern Daylight Time	08/04/2015 03:55:19 PM Eastern Daylight Time	08/04/2015 04:00:05 PM Eastern Daylight Time			08/04/2015 04:39:28 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	2016	Massachusetts except Berkshire Dukes and Nantucket		2	14100	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2						2			
H2230	016	0	1	04	01	H2230_016_0	7		1	07/17/2015	2016.01	07/17/2015 11:48:22 AM Eastern Daylight Time	08/04/2015 03:55:34 PM Eastern Daylight Time	08/04/2015 03:59:03 PM Eastern Daylight Time			08/04/2015 05:44:39 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	016	0	2016	Massachusetts except Berkshire Dukes and Nantucket		2	12000	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2						2			
H2230	017	0	1	04	01	H2230_017_0	6		1	07/17/2015	2016.01	07/17/2015 11:49:18 AM Eastern Daylight Time	08/04/2015 03:55:05 PM Eastern Daylight Time	08/04/2015 03:59:37 PM Eastern Daylight Time			08/04/2015 06:53:01 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	2016	Massachusetts except Berkshire Dukes and Nantucket		2	3000	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2						2			
H2230	801	0	1	04	01	H2230_801_0	4		1	05/27/2015	2016.01	05/27/2015 08:15:24 AM Eastern Daylight Time	06/01/2015 04:35:00 PM Eastern Daylight Time				06/01/2015 05:53:41 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	2016	National Network		1	2749	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		1	1	1a;1b;2;5;7d;7e;7h;9a;9b;9c;10a;11a;15;	2		1						2			
H2230	809	0	1	04	01	H2230_809_0	4		1	05/27/2015	2016.01	05/27/2015 08:36:03 AM Eastern Daylight Time	07/13/2015 01:48:31 PM Eastern Daylight Time				07/13/2015 03:00:54 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	2016	National Network		1	200	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265										(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254										1	1	1a;1b;2;5;7d;7e;7h;9a;9b;9c;10a;11a;15;	2		1						2			
H2237	001	0	1	01	01	H2237_001_0	12	2	1	08/11/2015	2016.01	08/11/2015 03:45:24 PM Central Daylight Time	08/03/2015 09:50:20 AM Central Daylight Time	07/31/2015 03:38:34 PM Central Daylight Time			08/11/2015 03:49:18 PM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icare-wi.org	iCare Medicare Plan (HMO SNP)	01	01		1			H2237	001	0	2016	iCare Medicare Plan		2	5900	2			1	3		1	2			www.icare-wi.org	www.icare-wi.org	www.icare-wi.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	9	2	1	08/11/2015	2016.01	08/11/2015 03:44:34 PM Central Daylight Time	08/03/2015 09:44:58 AM Central Daylight Time	07/31/2015 03:40:08 PM Central Daylight Time			08/11/2015 03:49:18 PM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icare-wi.org	iCare Family Care Partnership (HMO SNP)	01	01		1			H2237	007	0	2016	iCare Family Care Partnership		2	500	2			1	3		1	5			www.icare-wi.org	www.icare-wi.org	www.icare-wi.org	(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)777-4376		(414)223-4847		(800)947-3529		(414)223-4847		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2	2			
H2241	006	0	1	01	01	H2241_006_0	9		1	08/05/2015	2016.01	08/05/2015 08:42:52 AM Pacific Daylight Time	08/10/2015 03:02:24 PM Pacific Daylight Time	08/04/2015 03:18:31 PM Pacific Daylight Time			08/11/2015 10:02:11 AM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State Medicare Health Plan	www.GoldenStateMHP.com	Golden State Medicare Health Plan, Golden (HMO)	01	01		1			H2241	006	0	2016	LA/OC/RV/CC/SLO/STA Counties-Partial		2	6600	2			2							http://www.GoldenStateMHP.com/	www.goldenstatemhp.com	www.goldenstatemhp.com	(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		(877)541-4111		2					2					2	2			
H2256	001	1	1	01	01	H2256_001_1	14		1	08/03/2015	2016.01	08/03/2015 09:44:31 AM Eastern Daylight Time	07/31/2015 05:10:52 PM Eastern Daylight Time	07/30/2015 02:36:18 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	1	2016	Most of Massachusetts	Essex and Suffolk Counties	2	2558	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	001	2	1	01	01	H2256_001_2	14		1	08/03/2015	2016.01	08/03/2015 09:45:21 AM Eastern Daylight Time	07/31/2015 05:11:22 PM Eastern Daylight Time	07/30/2015 02:37:00 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	2	2016	Most of Massachusetts	BRIS, MIDD, NORF, PLYM, BARN Counties	2	15982	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	001	6	1	01	01	H2256_001_6	14		1	08/03/2015	2016.01	08/03/2015 09:45:46 AM Eastern Daylight Time	07/31/2015 05:11:52 PM Eastern Daylight Time	07/30/2015 02:37:40 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	6	2016	Most of Massachusetts	Hampden and Hampshire Counties	2	2324	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	015	1	1	01	01	H2256_015_1	14		1	08/03/2015	2016.01	08/03/2015 09:46:31 AM Eastern Daylight Time	07/31/2015 05:12:24 PM Eastern Daylight Time	07/30/2015 02:38:22 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	015	1	2016	Most of Massachusetts	Essex and Suffolk Counties	2	3254	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	015	2	1	01	01	H2256_015_2	14		1	08/03/2015	2016.01	08/03/2015 09:47:02 AM Eastern Daylight Time	07/31/2015 05:12:54 PM Eastern Daylight Time	07/30/2015 02:39:02 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	015	2	2016	Most of Massachusetts	BRIS, MIDD, NORF, PLYM, BARN Counties	2	14933	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	015	6	1	01	01	H2256_015_6	14		1	08/03/2015	2016.01	08/03/2015 09:47:29 AM Eastern Daylight Time	07/31/2015 05:13:24 PM Eastern Daylight Time	07/30/2015 02:39:42 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	015	6	2016	Most of Massachusetts	Hampden and Hampshire Counties	2	1607	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	016	1	1	01	01	H2256_016_1	13		1	07/21/2015	2016.01	07/21/2015 09:41:09 AM Eastern Daylight Time	07/22/2015 10:04:14 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	016	1	2016	Most of Massachusetts	Essex and, Suffolk Counties	2	210	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	016	2	1	01	01	H2256_016_2	10		1	07/21/2015	2016.01	07/21/2015 09:41:26 AM Eastern Daylight Time	07/22/2015 10:04:44 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	016	2	2016	Most of Massachusetts	BRIS, MIDD, NORF, PLYM, BARN Counties	2	1135	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	016	6	1	01	01	H2256_016_6	10		1	07/21/2015	2016.01	07/21/2015 09:41:45 AM Eastern Daylight Time	07/22/2015 10:05:14 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	016	6	2016	Most of Massachusetts	Hampden and Hampshire Counties	2	168	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	018	1	1	01	01	H2256_018_1	14		1	08/03/2015	2016.01	08/03/2015 09:56:19 AM Eastern Daylight Time	07/31/2015 05:53:36 PM Eastern Daylight Time	07/30/2015 02:40:22 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	1	2016	Most of Massachusetts	Essex and Suffolk Counties	2	1546	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	018	7	1	01	01	H2256_018_7	14		1	08/03/2015	2016.01	08/03/2015 09:57:10 AM Eastern Daylight Time	07/31/2015 05:54:06 PM Eastern Daylight Time	07/30/2015 02:41:02 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	7	2016	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2	5300	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	018	8	1	01	01	H2256_018_8	14		1	08/03/2015	2016.01	08/03/2015 09:57:48 AM Eastern Daylight Time	07/31/2015 05:54:34 PM Eastern Daylight Time	07/30/2015 02:41:44 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	8	2016	Most of Massachusetts	Hampden and Hampshire Counties	2	595	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	019	1	1	01	01	H2256_019_1	13		1	07/21/2015	2016.01	07/21/2015 09:42:54 AM Eastern Daylight Time	07/22/2015 10:07:14 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	019	1	2016	Most of Massachusetts	Essex and Suffolk Counties	2	103	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	019	7	1	01	01	H2256_019_7	13		1	07/21/2015	2016.01	07/21/2015 09:43:21 AM Eastern Daylight Time	07/22/2015 10:07:44 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	019	7	2016	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2	339	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	019	8	1	01	01	H2256_019_8	13		1	07/21/2015	2016.01	07/21/2015 09:43:59 AM Eastern Daylight Time	07/22/2015 10:08:14 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	019	8	2016	Most of Massachusetts	Hampden and Hampshire Counties	2	56	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	026	1	1	01	01	H2256_026_1	14		1	08/03/2015	2016.01	08/03/2015 10:01:30 AM Eastern Daylight Time	07/31/2015 05:15:34 PM Eastern Daylight Time	07/30/2015 02:42:26 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	1	2016	Most of Massachusetts	Essex and Suffolk Counties	2	2776	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	026	2	1	01	01	H2256_026_2	14		1	08/03/2015	2016.01	08/03/2015 10:04:12 AM Eastern Daylight Time	07/31/2015 05:16:08 PM Eastern Daylight Time	07/30/2015 02:43:08 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	2	2016	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM Counties	2	10121	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	026	3	1	01	01	H2256_026_3	14		1	08/03/2015	2016.01	08/03/2015 10:05:11 AM Eastern Daylight Time	07/31/2015 05:16:40 PM Eastern Daylight Time	07/30/2015 02:43:48 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	3	2016	Most of Massachusetts	Hampden and Hampshire Counties	2	1127	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	028	0	1	01	01	H2256_028_0	14		1	08/03/2015	2016.01	08/03/2015 09:37:39 AM Eastern Daylight Time	07/31/2015 05:17:12 PM Eastern Daylight Time	07/30/2015 02:44:30 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Saver Rx (HMO)	01	01		1			H2256	028	0	2016	BARN, BRIS, MIDD, NORF, PLYM, ESSEX, SUFF, WORC		2	10322	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	029	0	1	01	01	H2256_029_0	13	2	1	07/30/2015	2016.01	07/30/2015 01:05:22 PM Eastern Daylight Time	07/31/2015 10:38:06 AM Eastern Daylight Time	07/31/2015 10:38:06 AM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	thpmp.org/sco	Tufts Health Plan Senior Care Options (HMO SNP)	01	01		1			H2256	029	0	2016	Most of Massachusetts		2		2			1	3		1	5			thpmp.org/sco	thpmp.org/sco	thpmp.org/sco	(855)670-5934		(855)670-5934		(855)670-5935		(855)670-5935		(855)670-5934		(855)670-5934		(855)670-5935		(855)670-5935		(855)670-5936		(855)670-5936		(855)670-5940		(855)670-5940		(855)670-5936		(855)670-5936		(855)670-5940		(855)670-5940		2					2					2	2			
H2256	033	0	1	01	01	H2256_033_0	14		1	08/03/2015	2016.01	08/03/2015 09:49:33 AM Eastern Daylight Time	07/31/2015 05:17:44 PM Eastern Daylight Time	07/30/2015 02:45:12 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	033	0	2016	Worcester County		2	4865	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	034	0	1	01	01	H2256_034_0	14		1	08/03/2015	2016.01	08/03/2015 09:58:17 AM Eastern Daylight Time	07/31/2015 05:55:02 PM Eastern Daylight Time	07/30/2015 02:45:54 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	034	0	2016	Worcester County		2	2413	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	036	0	1	01	01	H2256_036_0	14		1	08/03/2015	2016.01	08/03/2015 10:10:38 AM Eastern Daylight Time	07/31/2015 05:18:50 PM Eastern Daylight Time	07/30/2015 02:46:36 PM Eastern Daylight Time			08/03/2015 05:53:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	036	0	2016	Worcester County		2	5315	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	039	0	1	01	01	H2256_039_0	13		1	07/21/2015	2016.01	07/21/2015 09:46:04 AM Eastern Daylight Time	07/22/2015 10:12:22 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	039	0	2016	Worcester County		2	129	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(855)670-5934		(855)670-5934		(877)218-4835		(877)218-4835										(855)670-5936		(855)670-5936		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	040	0	1	01	01	H2256_040_0	13		1	07/21/2015	2016.01	07/21/2015 09:46:23 AM Eastern Daylight Time	07/22/2015 10:12:52 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	040	0	2016	Worcester County		2	308	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(855)670-5934		(855)670-5934		(877)218-4835		(877)218-4835										(855)670-5936		(855)670-5936		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	041	0	1	01	01	H2256_041_0	13		1	07/21/2015	2016.01	07/21/2015 09:46:39 AM Eastern Daylight Time	07/22/2015 10:13:22 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic No Rx (HMO)	01	01		1			H2256	041	0	2016	Worcester County		2	506	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(855)670-5934		(855)670-5934		(877)218-4835		(877)218-4835										(855)670-5936		(855)670-5936		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	042	0	1	01	01	H2256_042_0	13		1	07/21/2015	2016.01	07/21/2015 09:46:56 AM Eastern Daylight Time	07/22/2015 10:13:52 AM Eastern Daylight Time				07/23/2015 03:35:24 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic No Rx (HMO)	01	01		1			H2256	042	0	2016	Essex and Suffolk Counties		2	229	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	801	0	1	01	01	H2256_801_0	11		1	05/31/2015	2016.01	05/31/2015 12:08:53 PM Eastern Daylight Time	06/01/2015 12:09:50 PM Eastern Daylight Time				06/01/2015 04:29:18 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Rx (HMO)	01	01		1			H2256	801	0	2016	Most of Massachusetts		1	12516	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2256	802	0	1	01	01	H2256_802_0	11		1	05/31/2015	2016.01	05/31/2015 12:10:07 PM Eastern Daylight Time	06/01/2015 12:10:16 PM Eastern Daylight Time				06/01/2015 04:29:18 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO (HMO)	01	01		1			H2256	802	0	2016	Most of Massachusetts		1	828	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978										2					2					2	2			
H2256	803	0	1	01	01	H2256_803_0	11		1	05/31/2015	2016.01	05/31/2015 12:11:02 PM Eastern Daylight Time	06/01/2015 12:10:42 PM Eastern Daylight Time				06/01/2015 04:29:18 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Rx (HMO)	01	01		1			H2256	803	0	2016	Most of Massachusetts		1	1	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	http://tuftsmedicarepreferred.org/drug-coverage	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978		2					2					2	2			
H2261	005	0	1	01	01	H2261_005_0	10		1	07/10/2015	2016.01	07/10/2015 09:49:35 AM Eastern Daylight Time	08/04/2015 03:56:51 PM Eastern Daylight Time	08/04/2015 04:01:05 PM Eastern Daylight Time			08/05/2015 08:12:58 AM 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	2016	Massachusetts except Berkshire Dukes and Nantucket		2	6000	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2					2	2			
H2261	019	0	1	01	01	H2261_019_0	9		1	07/10/2015	2016.01	07/10/2015 09:51:49 AM Eastern Daylight Time	08/04/2015 03:56:38 PM Eastern Daylight Time	08/04/2015 04:01:19 PM Eastern Daylight Time			08/05/2015 08:22:28 AM 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	019	0	2016	Massachusetts except Berkshire Dukes and Nantucket		2	1800	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2					2	2			
H2261	021	0	1	02	01	H2261_021_0	7		1	09/14/2015	2016.01	09/14/2015 11:50:57 AM Eastern Daylight Time	08/04/2015 03:57:53 PM Eastern Daylight Time	08/04/2015 03:59:48 PM Eastern Daylight Time			09/14/2015 12:06:09 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	021	0	2016	Massachusetts except Berkshire Dukes and Nantucket		2	1000	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2					2	2			
H2261	801	0	1	01	01	H2261_801_0	5		1	05/14/2015	2016.01	05/14/2015 09:44:48 AM Eastern Daylight Time	05/31/2015 09:17:00 PM Eastern Daylight Time				06/01/2015 10:00:17 AM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue (HMO)	01	01		1			H2261	801	0	2016	Massachusetts except Berkshire Dukes and Nantucket		1	2700	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;9b;9c;11a;11b;	1	7d;7f;	1					1	2			
H2261	809	0	1	01	01	H2261_809_0	6		1	05/14/2015	2016.01	05/14/2015 09:49:30 AM Eastern Daylight Time	07/14/2015 07:48:22 AM Eastern Daylight Time				07/14/2015 07:52:26 AM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue (HMO)	01	01		1			H2261	809	0	2016	Massachusetts except Berkshire Dukes and Nantucket		1	50	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265										(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254										1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;9b;9c;11a;11b;	1	7d;7f;	1					1	2			
H2312	004	0	1	01	01	H2312_004_0	9		1	07/10/2015	2016.01	07/10/2015 09:34:39 AM Eastern Daylight Time	08/04/2015 03:50:46 PM Eastern Daylight Time	08/04/2015 03:51:35 PM Eastern Daylight Time			08/04/2015 04:08:42 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Henry Ford (HMO)	01	01		1			H2312	004	0	2016	Southeastern Michigan (3 Counties)		2	14316	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2312	006	0	1	01	01	H2312_006_0	7		1	07/10/2015	2016.01	07/10/2015 09:34:29 AM Eastern Daylight Time	06/29/2015 03:22:10 PM Eastern Daylight Time				07/10/2015 10:32:20 AM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Henry Ford (HMO)	01	01		1			H2312	006	0	2016	Southeastern Michigan (3 Counties)		2	351	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2312	007	0	1	02	01	H2312_007_0	9		1	07/20/2015	2016.01	07/20/2015 01:08:15 PM Eastern Daylight Time	08/04/2015 03:50:46 PM Eastern Daylight Time	08/04/2015 03:51:35 PM Eastern Daylight Time			08/04/2015 04:08:42 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Expanded Network (HMO-POS)	01	02		1			H2312	007	0	2016	Southeastern Michigan (10 Counties)		2	7698	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2312	010	0	1	02	01	H2312_010_0	8		1	07/10/2015	2016.01	07/10/2015 09:34:01 AM Eastern Daylight Time	08/04/2015 03:50:46 PM Eastern Daylight Time	08/04/2015 03:51:35 PM Eastern Daylight Time			08/04/2015 04:08:42 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Expanded Network (HMO-POS)	01	02		1			H2312	010	0	2016	Southeastern Michigan (10 Counties)		2	1430	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2312	012	0	1	02	01	H2312_012_0	8		1	07/10/2015	2016.01	07/10/2015 09:37:15 AM Eastern Daylight Time	08/04/2015 03:50:46 PM Eastern Daylight Time	08/04/2015 03:51:35 PM Eastern Daylight Time			08/04/2015 04:08:42 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Expanded Network (HMO-POS)	01	02		1			H2312	012	0	2016	Southeastern Michigan (10 Counties)		2	1423	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2312	801	0	1	01	01	H2312_801_0	6		1	05/27/2015	2016.01	05/27/2015 10:04:04 AM Eastern Daylight Time	06/30/2015 09:28:30 AM Eastern Daylight Time				07/02/2015 04:22:25 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Group Only (HMO)	01	01		1			H2312	801	0	2016	Michigan		1	961	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7c;7e;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;8a;8b1;8b2;9a;9b;12;16b;	1					2	2			
H2312	803	0	1	01	01	H2312_803_0	6		1	05/27/2015	2016.01	05/27/2015 10:04:14 AM Eastern Daylight Time	06/30/2015 09:29:12 AM Eastern Daylight Time				07/02/2015 04:22:25 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Group Only (HMO)	01	01		1			H2312	803	0	2016	Michigan		1	1	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7c;7e;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;8a;8b1;8b2;9a;9b;12;16b;	1					2	2			
H2312	805	0	1	01	01	H2312_805_0	6		1	05/27/2015	2016.01	05/27/2015 10:04:23 AM Eastern Daylight Time	06/30/2015 09:29:54 AM Eastern Daylight Time				07/02/2015 04:22:25 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Group Only (HMO)	01	01		1			H2312	805	0	2016	Michigan		1	14423	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7c;7e;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;8a;8b1;8b2;9a;9b;12;16b;	1					2	2			
H2312	807	0	1	01	01	H2312_807_0	6		1	05/27/2015	2016.01	05/27/2015 10:04:34 AM Eastern Daylight Time	06/30/2015 09:30:34 AM Eastern Daylight Time				07/02/2015 04:22:25 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Group Only (HMO)	01	01		1			H2312	807	0	2016	Michigan		1	5625	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7c;7e;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;8a;8b1;8b2;9a;9b;12;16b;	1					2	2			
H2312	809	0	1	01	01	H2312_809_0	6		1	05/27/2015	2016.01	05/27/2015 10:04:44 AM Eastern Daylight Time	06/30/2015 09:31:14 AM Eastern Daylight Time				07/02/2015 04:22:25 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org	HAP Senior Plus - Group Non Cal (HMO) (HMO)	01	01		1			H2312	809	0	2016	Michigan		1	8	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7c;7e;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;8a;8b1;8b2;9a;9b;12;16b;	1					2	2			
H2312	810	0	1	01	01	H2312_810_0	6		1	05/27/2015	2016.01	05/27/2015 10:04:51 AM Eastern Daylight Time	06/30/2015 09:31:56 AM Eastern Daylight Time				07/02/2015 04:22:25 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org	HAP Senior Plus - Group Only non Cal (HMO) (HMO)	01	01		1			H2312	810	0	2016	Michigan		1	8	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7c;7e;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;14a;15;16b;	1	7b;7d;7f;7g;8a;8b1;8b2;9a;9b;12;16b;	1					2	2			
H2318	001	0	1	20	08	H2318_001_0	1		1	05/27/2015	2016.01	05/27/2015 01:12:20 PM Eastern Daylight Time		05/21/2015 07:46:05 AM Eastern Daylight Time			05/27/2015 01:25:28 PM Eastern Daylight Time	CENTER FOR SENIOR INDEPENDENCE	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	08	20		1			H2318	001	0	2016	Michigan, Wayne County Area		2		2			2								Milwaukee.PACE@milliman.com	henryford.com									(855)445-4554		(313)543-6320		(855)445-4554		(313)543-6320										(313)916-2600		(313)876-4756		(313)916-2600		(313)876-4756																
H2318	002	0	1	20	08	H2318_002_0	1		1	05/27/2015	2016.01	05/27/2015 01:21:38 PM Eastern Daylight Time		05/21/2015 07:47:31 AM Eastern Daylight Time			05/27/2015 01:25:28 PM Eastern Daylight Time	CENTER FOR SENIOR INDEPENDENCE	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	08	20		1			H2318	002	0	2016	Michigan, Wayne County Area		2		2			2								Milwaukee.PACE@milliman.com	henryford.com									(855)445-4554		(313)543-6320		(855)445-4554		(313)543-6320										(313)916-2600		(313)876-4756		(313)916-2600		(313)876-4756																
H2320	007	0	1	02	01	H2320_007_0	6		1	08/04/2015	2016.01	08/04/2015 11:17:14 AM Eastern Daylight Time	07/30/2015 05:52:02 PM Eastern Daylight Time	07/31/2015 10:54:20 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	007	0	2016	Region 2		2	2615	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	008	0	1	02	01	H2320_008_0	6		1	07/16/2015	2016.01	07/16/2015 05:55:39 PM Eastern Daylight Time	07/30/2015 05:52:36 PM Eastern Daylight Time	07/31/2015 10:54:46 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	008	0	2016	Region 3		2	1407	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	011	0	1	02	01	H2320_011_0	5		1	07/16/2015	2016.01	07/16/2015 05:53:40 PM Eastern Daylight Time	07/30/2015 05:53:12 PM Eastern Daylight Time	07/31/2015 10:55:10 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	011	0	2016	Region 2		2	7194	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	012	0	1	02	01	H2320_012_0	5		1	07/16/2015	2016.01	07/16/2015 05:55:57 PM Eastern Daylight Time	07/30/2015 05:53:44 PM Eastern Daylight Time	07/31/2015 10:55:34 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	012	0	2016	Region 3		2	2782	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	013	0	1	02	01	H2320_013_0	5		1	07/16/2015	2016.01	07/16/2015 05:56:13 PM Eastern Daylight Time	07/30/2015 05:54:18 PM Eastern Daylight Time	07/31/2015 10:56:00 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	013	0	2016	Region 1		2	13139	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	015	0	1	02	01	H2320_015_0	5		1	07/16/2015	2016.01	07/16/2015 05:56:28 PM Eastern Daylight Time	07/30/2015 05:54:52 PM Eastern Daylight Time	07/31/2015 10:56:24 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	015	0	2016	Region 1		2	34094	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	016	0	1	02	01	H2320_016_0	6		1	07/16/2015	2016.01	07/16/2015 05:56:43 PM Eastern Daylight Time	07/31/2015 01:02:48 PM Eastern Daylight Time	07/31/2015 10:56:48 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	016	0	2016	Region 4		2	405	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	018	0	1	02	01	H2320_018_0	5		1	07/16/2015	2016.01	07/16/2015 05:58:21 PM Eastern Daylight Time	07/30/2015 05:56:00 PM Eastern Daylight Time	07/31/2015 10:57:14 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	018	0	2016	Region 4		2	1782	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	019	0	1	02	01	H2320_019_0	5		1	07/16/2015	2016.01	07/16/2015 05:58:38 PM Eastern Daylight Time	07/30/2015 05:56:32 PM Eastern Daylight Time	07/31/2015 10:57:38 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	019	0	2016	Region 5		2	488	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	021	0	1	02	01	H2320_021_0	5		1	07/16/2015	2016.01	07/16/2015 05:58:56 PM Eastern Daylight Time	07/30/2015 05:57:06 PM Eastern Daylight Time	07/31/2015 10:58:04 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	021	0	2016	Region 5		2	2203	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	1	1	02	01	H2320_022_1	6		1	07/16/2015	2016.01	07/16/2015 05:50:04 PM Eastern Daylight Time	07/30/2015 05:57:40 PM Eastern Daylight Time	07/31/2015 10:58:30 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	1	2016	68 lower peninsula Michigan counties	MI counties: AG, BR, KN, LN, NW, OW	2	307	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	2	1	02	01	H2320_022_2	5		1	07/16/2015	2016.01	07/16/2015 05:50:37 PM Eastern Daylight Time	07/30/2015 05:58:14 PM Eastern Daylight Time	07/31/2015 10:58:54 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	2	2016	68 lower peninsula Michigan counties	MI counties: 7 west, 6 mid-MI, 2 north and 1 east	2	519	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	3	1	02	01	H2320_022_3	5		1	07/16/2015	2016.01	07/16/2015 05:50:49 PM Eastern Daylight Time	07/30/2015 05:58:48 PM Eastern Daylight Time	07/31/2015 10:59:20 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	3	2016	68 lower peninsula Michigan counties	MI counties: 4 SW, 9 north and 4 mid-MI	2	419	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	4	1	02	01	H2320_022_4	5		1	07/16/2015	2016.01	07/16/2015 05:51:00 PM Eastern Daylight Time	07/30/2015 05:59:22 PM Eastern Daylight Time	07/31/2015 10:59:46 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	4	2016	68 lower peninsula Michigan counties	MI counties: 3 SE, 3 SW, 6 NE, 2 NW and 3 mid-MI	2	383	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	022	5	1	02	01	H2320_022_5	5		1	07/16/2015	2016.01	07/16/2015 05:51:11 PM Eastern Daylight Time	07/30/2015 05:59:56 PM Eastern Daylight Time	07/31/2015 11:00:12 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	01	02		1			H2320	022	5	2016	68 lower peninsula Michigan counties	MI counties: 11 east and 1 SW	2	1685	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	802	0	1	02	01	H2320_802_0	5		1	05/30/2015	2016.01	05/30/2015 02:23:08 PM Eastern Daylight Time	07/13/2015 05:57:46 PM Eastern Daylight Time				07/17/2015 03:44:16 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	2016	National		1	1029	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	803	0	1	02	01	H2320_803_0	5		1	05/30/2015	2016.01	05/30/2015 02:24:25 PM Eastern Daylight Time	07/13/2015 05:56:52 PM Eastern Daylight Time				07/17/2015 03:44:16 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG Calendar Year (HMO-POS)	01	02		1			H2320	803	0	2016	National		1	14449	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	804	0	1	01	01	H2320_804_0	5		1	05/30/2015	2016.01	05/30/2015 02:25:29 PM Eastern Daylight Time	07/13/2015 05:56:20 PM Eastern Daylight Time				07/17/2015 03:44:16 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	2016	State of Michigan		1	290	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	805	0	1	01	01	H2320_805_0	5		1	05/30/2015	2016.01	05/30/2015 02:26:18 PM Eastern Daylight Time	07/13/2015 05:55:30 PM Eastern Daylight Time				07/17/2015 03:44:16 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	2016	State of Michigan		1	81	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2322	004	0	1	04	01	H2322_004_0	7		1	07/10/2015	2016.01	07/10/2015 09:54:01 AM Eastern Daylight Time	08/04/2015 03:50:47 PM Eastern Daylight Time	08/04/2015 03:51:35 PM Eastern Daylight Time			08/04/2015 04:08:42 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org/Medicare	Alliance Medicare PPO (PPO)	01	04		1			H2322	004	0	2016	Southeastern Michigan (9 Counties)		2	2955	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	008	0	1	04	01	H2322_008_0	7		1	07/10/2015	2016.01	07/10/2015 09:54:09 AM Eastern Daylight Time	08/04/2015 03:50:41 PM Eastern Daylight Time	08/04/2015 03:51:35 PM Eastern Daylight Time			08/04/2015 04:08:42 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org/Medicare	Alliance Medicare PPO (PPO)	01	04		1			H2322	008	0	2016	Southeastern Michigan (9 Counties)		2	1148	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	801	0	1	04	01	H2322_801_0	5		1	05/27/2015	2016.01	05/27/2015 10:05:24 AM Eastern Daylight Time	05/31/2015 05:32:00 PM Eastern Daylight Time				05/31/2015 05:37:34 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org/Medicare	Alliance Medicare PPO - Group Only (PPO)	01	04		1			H2322	801	0	2016	Michigan		1	8	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7c;7e;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;12;14a;15;	1	7b;7d;8a;8b1;8b2;9a;9b;12;16b;	1						2			
H2322	803	0	1	04	01	H2322_803_0	5		1	05/27/2015	2016.01	05/27/2015 11:12:11 AM Eastern Daylight Time	05/31/2015 05:32:00 PM Eastern Daylight Time				05/31/2015 05:37:34 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org/Medicare	Alliance Medicare PPO - Group Only (PPO)	01	04		1			H2322	803	0	2016	Michigan		1	8	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7c;7e;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;12;14a;15;	1	7b;7d;8a;8b1;8b2;9a;9b;12;16b;	1						2			
H2322	809	0	1	04	01	H2322_809_0	5		1	05/27/2015	2016.01	05/27/2015 10:05:38 AM Eastern Daylight Time	05/31/2015 05:32:00 PM Eastern Daylight Time				05/31/2015 05:37:34 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org	Alliance Medicare PPO - Group Only Non Cal (PPO)	01	04		1			H2322	809	0	2016	Michigan		1	8	1	1		2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7c;7e;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;12;14a;15;	1	7b;7d;8a;8b1;8b2;9a;9b;12;16b;	1						2			
H2354	001	0	1	01	01	H2354_001_0	6		1	08/05/2015	2016.01	08/05/2015 12:05:12 PM Eastern Daylight Time	08/05/2015 03:08:42 PM Eastern Daylight Time	08/05/2015 02:14:10 PM Eastern Daylight Time			08/06/2015 12:35:33 AM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	HealthPlus MedicarePlus Option 1 (HMO)	01	01		1			H2354	001	0	2016	22 Mid-Michigan and Southeast Michigan Counties		2	4000	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					2					2	2			
H2354	015	0	1	01	01	H2354_015_0	5		1	08/05/2015	2016.01	08/05/2015 11:55:48 AM Eastern Daylight Time	08/05/2015 03:09:02 PM Eastern Daylight Time	08/05/2015 04:37:06 PM Eastern Daylight Time			08/06/2015 12:35:33 AM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	HealthPlus MedicarePlus Option 0 (HMO)	01	01		1			H2354	015	0	2016	22 Mid-Michigan and Southeast Michigan Counties		2	274	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					2					2	2			
H2354	801	0	1	01	01	H2354_801_0	2		1	05/29/2015	2016.01	05/29/2015 10:24:15 AM Eastern Daylight Time	06/02/2015 02:20:05 PM Eastern Daylight Time				06/02/2015 02:26:56 PM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	Emp-only - HealthPlus MA-only (HMO)	01	01		1			H2354	801	0	2016	United States EG Area		1		2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161										(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070										2					2					2	2			
H2354	802	0	1	02	01	H2354_802_0	2		1	06/01/2015	2016.01	06/01/2015 04:54:35 PM Eastern Daylight Time	06/02/2015 02:20:05 PM Eastern Daylight Time				06/02/2015 02:26:56 PM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	Emp-only - HealthPlus MA-PD calendar yr. (HMO-POS)	01	02		1			H2354	802	0	2016	United States EG Area		1	313	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					1	2		2		2	2			
H2354	805	0	1	02	01	H2354_805_0	2		1	06/01/2015	2016.01	06/01/2015 04:54:44 PM Eastern Daylight Time	06/02/2015 02:20:06 PM Eastern Daylight Time				06/02/2015 02:26:56 PM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	Emp-only - HealthPlus MA-PD non-calendar yr. (HMO-POS)	01	02		1			H2354	805	0	2016	United States EG Area		1	313	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					1	2		2		2	2			
H2386	001	0	1	20	08	H2386_001_0	2		1	05/21/2015	2016.01	05/21/2015 01:10:41 PM Eastern Daylight Time		05/20/2015 04:52:59 PM Eastern Daylight Time			05/21/2015 01:12:58 PM Eastern Daylight Time	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	Appalachian Agency for Senior Citizens, Inc,	www.aasc.org	AllCARE for Seniors - Duals (PACE)	08	20		1			H2386	001	0	2016	Counties:  Buchanan, Dickenson, Russell, Tazewell		2		2			2								www.aasc.org	www.seniorscript.com									(800)656-2272	7152	(276)964-4915	7152	(800)656-2272	7152	(276)964-4915	7152									(800)656-2272	7152	(276)964-4915	7152	(800)656-2272	7152	(276)964-4915	7152															
H2386	002	0	1	20	08	H2386_002_0	2		1	05/21/2015	2016.01	05/21/2015 01:11:23 PM Eastern Daylight Time		05/20/2015 04:58:49 PM Eastern Daylight Time			05/21/2015 01:12:58 PM Eastern Daylight Time	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	Appalachian Agency for Senior Citizens, Inc,	www.aasc.org	AllCARE for Seniors - Medicare only (PACE)	08	20		1			H2386	002	0	2016	Counties:  Buchanan, Dickenson, Russell, Tazewell		2		2			2								www.aasc.org	www.seniorscript.com									(800)656-2272	7152	(276)964-4915	7152	(800)656-2272	7152	(276)964-4915	7152									(800)656-2272	7152	(276)964-4915	7152	(800)656-2272	7152	(276)964-4915	7152															
H2400	001	0	1	01	01	H2400_001_0	6		1	08/05/2015	2016.01	08/05/2015 11:38:50 AM Eastern Daylight Time	08/03/2015 07:16:03 PM Eastern Daylight Time	08/03/2015 05:03:31 PM Eastern Daylight Time			08/05/2015 02:22:21 PM Eastern Daylight Time	SIGNATURE ADVANTAGE, LLC	Signature Advantage (HMO SNP)	www.signatureadvantageplan.com	Signature Advantage (HMO SNP)	01	01		1			H2400	001	0	2016	KY Counties: CLK, FAY, JEF, SC & SP		2		2			1	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		(800)648-6057		(711)-		(800)648-6057		(711)-		(800)648-6057		(711)-		(800)648-6057		(711)-		2					1					2	2			
H2406	001	0	1	04	01	H2406_001_0	3		1	07/31/2015	2016.01	07/31/2015 09:39:33 AM Central Daylight Time	07/31/2015 02:08:00 PM Central Daylight Time	07/30/2015 09:32:00 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2406	001	0	2016	Select Counties in Ohio		2		2			1	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	805	0	1	04	01	H2406_805_0	1		1	04/23/2015	2016.01	04/23/2015 02:35:43 PM Central Daylight Time	05/29/2015 02:49:29 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2406	805	0	2016	Nationwide		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H2411	803	0	1	04	01	H2411_803_0	2		1	06/01/2015	2016.01	06/01/2015 10:05:40 AM Eastern Daylight Time	06/01/2015 11:35:36 AM Eastern Daylight Time				06/01/2015 11:56:17 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	MA-PD PPO (PPO)	01	04		1			H2411	803	0	2016	Full Service Area - Employer Groups		1	15	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8b1;8b2;8b3;9a;9b;18a;	1						2			
H2416	001	0	1	01	01	H2416_001_0	2	2	1	08/04/2015	2016.01	08/04/2015 04:51:17 PM Central Daylight Time	08/03/2015 02:43:26 PM Central Daylight Time	08/03/2015 05:38:09 PM Central Daylight Time			08/04/2015 04:56:42 PM Central Daylight Time	PRIMEWEST CTRL COUNTY-BASED PURCHASING INITIATIVE	PrimeWest Health	www.primewest.org/Members/PWSHC_HMO.aspx	PrimeWest Senior Health Complete (HMO SNP)	01	01		1			H2416	001	0	2016	Northern, west central, and southwestern Minnesota		2	2439	2			1	3		1	5			www.primewest.org/FindA/Default.aspx	http://www.primewest.org/FindA/Drug.aspx	http://www.primewest.org/FindA/Pharmacy.aspx	(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		1	1	1a;1b;2;5;7b;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;	2		1					1	2			
H2417	001	0	1	01	01	H2417_001_0	3	2	1	06/01/2015	2016.01	06/01/2015 03:43:31 PM Central Daylight Time	08/03/2015 11:37:35 AM Central Daylight Time	08/03/2015 11:38:26 AM Central Daylight Time			08/04/2015 04:47:38 PM Central Daylight Time	ITASCA MEDICAL CARE	Itasca Medical Care/IMCare Classic	www.imcare.org	IMCare Classic (HMO SNP)	01	01		1			H2417	001	0	2016	Itasca County		2	480	2			1	3		1	5			http://www.imcare.org	http://www.imcare.org	http://www.caremark.com/wps/portal	(800)843-9536		(218)327-6188		(800)843-9536		(218)327-6188		(800)843-9536		(218)327-6188		(800)843-9536		(218)327-6188		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;9b;9c;9d;10a;11a;11b;11c;12;18a;	1	1b;2;5;6;7c;7d;7e;7f;7g;7h;7i;9b;9c;9d;12;18a;	1					1	2			
H2419	001	0	1	01	01	H2419_001_0	3	2	1	07/07/2015	2016.01	07/07/2015 03:21:11 PM Central Daylight Time	08/03/2015 03:59:25 PM Central Daylight Time	08/03/2015 03:49:38 PM Central Daylight Time			08/04/2015 10:38:07 AM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	SeniorCare Complete (HMO SNP)	01	01		1			H2419	001	0	2016	Select Counties in Minnesota		2	1458	1	1		1	3		1	5			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	5	2	1	08/05/2015	2016.01	08/05/2015 08:50:05 AM Central Daylight Time	08/05/2015 11:20:00 AM Central Daylight Time	07/30/2015 10:48:44 AM Central Daylight Time			08/05/2015 12:29:44 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/msho	HealthPartners Minnesota Senior Health Options (HMO SNP)	01	01		1			H2422	002	0	2016	Minneapolis/St. Paul Metro Area		2		2			1	3		1	5			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		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2	2			
H2425	001	0	1	01	01	H2425_001_0	10	2	1	07/15/2015	2016.01	07/15/2015 10:22:36 AM Central Daylight Time	08/03/2015 11:32:22 AM Central Daylight Time	07/30/2015 10:25:39 AM Central Daylight Time			08/03/2015 11:58:29 AM Central Daylight Time	BLUE PLUS	Blue Plus	www.bluecrossmn.com/secureblue	SecureBlue (HMO SNP)	01	01		1			H2425	001	0	2016	62 Counties within the State of Minnesota		2	7543	2			1	3		1	5			www.bluecrossmn.com/secureblue	www.myprime.com	www.myprime.com	(888)740-6013		(651)662-6013		(866)477-1584		(651)662-3584		(888)740-6013		(651)662-6013		(866)477-1584		(651)662-3584		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H2450	001	0	1	18	06	H2450_001_0	4		1	07/31/2015	2016.01	07/31/2015 11:58:45 AM Central Daylight Time		07/31/2015 10:41:43 AM Central Daylight Time			07/31/2015 12:41:25 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Basic w/Rx 2 (Cost)	06	18		1			H2450	001	0	2016	All of MN, plus select counties in ND, SD and WI		2	169452	2			2							www.medica.com/Members	www.medica.com/Members	www.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	07/31/2015	2016.01	07/31/2015 11:59:35 AM Central Daylight Time		07/31/2015 10:44:34 AM Central Daylight Time			07/31/2015 12:41:25 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Enhanced w/Rx 2 (Cost)	06	18		1			H2450	002	0	2016	All of MN, plus select counties in ND, SD and WI		2	230196	2			2							www.medica.com/Members	www.medica.com/Members	www.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	07/31/2015	2016.01	07/31/2015 12:00:13 PM Central Daylight Time		07/31/2015 10:45:30 AM Central Daylight Time			07/31/2015 12:41:25 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Thrift w/Rx (Cost)	06	18		1			H2450	007	0	2016	All of MN, plus select counties in ND, SD and WI		2	15055	2			2							www.medica.com/Members	www.medica.com/Members	www.medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	016	0	1	18	06	H2450_016_0	4		1	07/31/2015	2016.01	07/31/2015 12:01:56 PM Central Daylight Time		07/31/2015 10:46:27 AM Central Daylight Time			07/31/2015 12:41:25 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Basic w/Rx (Cost)	06	18		1			H2450	016	0	2016	All of MN, plus select counties in ND, SD and WI		2	290594	2			2							www.medica.com/Members	www.medica.com/Members	www.medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	017	0	1	18	06	H2450_017_0	3		1	07/31/2015	2016.01	07/31/2015 12:02:31 PM Central Daylight Time		07/31/2015 10:47:14 AM Central Daylight Time			07/31/2015 12:41:25 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Enhanced w/Rx (Cost)	06	18		1			H2450	017	0	2016	All of MN, plus select counties in ND, SD and WI		2	194283	2			2							www.medica.com/Members	www.medica.com/Members	www.medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	022	0	1	18	06	H2450_022_0	3		1	07/31/2015	2016.01	07/31/2015 12:03:11 PM Central Daylight Time		07/31/2015 10:59:56 AM Central Daylight Time			07/31/2015 12:41:25 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Value w/Rx (Cost)	06	18		1			H2450	022	0	2016	All of MN, plus select counties in ND, SD and WI		2	79349	2			2							www.medica.com/Members	www.medica.com/Members	www.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	023	0	1	18	06	H2450_023_0	3		1	07/31/2015	2016.01	07/31/2015 12:03:45 PM Central Daylight Time		07/31/2015 10:49:03 AM Central Daylight Time			07/31/2015 12:41:25 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Value w/Rx 2 (Cost)	06	18		1			H2450	023	0	2016	All of MN, plus select counties in ND, SD and WI		2	22776	2			2							www.medica.com/Members	www.medica.com/Members	www.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	029	0	1	18	06	H2450_029_0	3		1	07/31/2015	2016.01	07/31/2015 12:04:16 PM Central Daylight Time		07/31/2015 10:50:11 AM Central Daylight Time			07/31/2015 12:41:25 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Thrive w/Rx (Cost)	06	18		1			H2450	029	0	2016	All of MN		2	22401	2			2							www.medica.com/Members	www.medica.com/Members	www.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	801	0	1	18	06	H2450_801_0	1		1	05/21/2015	2016.01	05/21/2015 03:16:49 PM Central Daylight Time					05/27/2015 04:00:03 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Group Prime Solution w/Rx (Cost)	06	18		1			H2450	801	0	2016	All of MN, plus select Counties in ND, SD and WI		1	121630	2			2							www.medica.com/Members	www.medica.com/Members	www.medica.com/Members	(800)575-2330		(952)992-2330		(800)575-2330		(952)992-2330		(800)575-2330		(952)992-2330		(800)575-2330		(952)992-2330		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-													2			
H2456	002	0	1	01	01	H2456_002_0	9	2	1	08/10/2015	2016.01	08/10/2015 03:14:48 PM Central Daylight Time	08/10/2015 01:06:23 PM Central Daylight Time	07/30/2015 12:43:28 PM Central Daylight Time			08/10/2015 03:22:02 PM Central Daylight Time	UCARE MINNESOTA	UCare's MSHO	www.ucare.org	UCare's Minnesota Senior Health Options (HMO SNP)	01	01		1			H2456	002	0	2016	Twin Cities Metropolitan area and Greater MN		2		2			1	3		1	5			www.ucare.org	www.ucare.org	www.ucare.org	(866)280-7202		(612)676-6868		(800)707-1711		(612)676-3554		(866)280-7202		(612)676-6868		(800)707-1711		(612)676-3554		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2458	002	0	1	01	01	H2458_002_0	6	2	1	08/05/2015	2016.01	08/05/2015 12:55:23 PM Central Daylight Time	08/04/2015 03:01:12 PM Central Daylight Time	07/31/2015 09:27:50 AM Central Daylight Time			08/05/2015 01:13:32 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	www.medica.com	Medica DUAL Solution (HMO SNP)	01	01		1			H2458	002	0	2016	Specific Minnesota Counties		2	119064	2			1	3		1	5			www.medica.com/Medicare	www.medica.com/Members	https://www.medica.com/pharmacy/medicaid/medica-dual-solution	(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	7		1	07/14/2015	2016.01	07/14/2015 03:27:45 PM Central Daylight Time	06/30/2015 12:16:23 AM Central Daylight Time				07/16/2015 10:06:25 AM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare for Seniors Value (HMO-POS)	01	02		1			H2459	001	0	2016	Minnesota		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500										(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810										2					2					2	2			
H2459	002	0	1	02	01	H2459_002_0	12		1	07/14/2015	2016.01	07/14/2015 04:07:49 PM Central Daylight Time	07/30/2015 11:24:11 AM Central Daylight Time	07/30/2015 12:45:40 PM Central Daylight Time			08/04/2015 07:55:29 AM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare for Seniors Classic (HMO-POS)	01	02		1			H2459	002	0	2016	44 Counties		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	013	0	1	02	01	H2459_013_0	9		1	07/14/2015	2016.01	07/14/2015 03:29:17 PM Central Daylight Time	07/30/2015 11:25:07 AM Central Daylight Time	07/30/2015 12:46:54 PM Central Daylight Time			08/04/2015 07:55:29 AM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare for Seniors Value Plus (HMO-POS)	01	02		1			H2459	013	0	2016	44 Counties		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	019	0	1	02	01	H2459_019_0	9		1	07/14/2015	2016.01	07/14/2015 03:29:05 PM Central Daylight Time	07/30/2015 11:26:05 AM Central Daylight Time	07/30/2015 12:34:18 PM Central Daylight Time			08/04/2015 07:55:29 AM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare for Seniors Essentials Rx (HMO-POS)	01	02		1			H2459	019	0	2016	Minnesota		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2	2			
H2459	801	0	1	02	01	H2459_801_0	5		1	06/01/2015	2016.01	06/01/2015 04:25:35 PM Central Daylight Time	05/31/2015 10:11:46 PM Central Daylight Time				06/01/2015 07:06:14 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	Group UCare for Seniors (HMO-POS)	01	02		1			H2459	801	0	2016	Minnesota and 26 Wisconsin Counties		1		2			2							www.ucare.org	www.ucare.org	www.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		1	2		2		1	2		2		2	2			
H2461	005	0	1	18	06	H2461_005_0	4		1	07/10/2015	2016.01	07/10/2015 01:36:36 PM Central Daylight Time					07/13/2015 04:30:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Core Plan (Cost)	06	18		1			H2461	005	0	2016	State of Minnesota		2	6003	2			2								www.bluecrossmn.com	www.primetherapeutics.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2461	006	0	1	18	06	H2461_006_0	3		1	07/10/2015	2016.01	07/10/2015 01:42:15 PM Central Daylight Time					07/13/2015 04:30:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Choice Plan (Cost)	06	18		1			H2461	006	0	2016	State of Minnesota		2	43561	2			2								www.bluecrossmn.com	www.primetherapeutics.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2461	007	0	1	18	06	H2461_007_0	3		1	07/10/2015	2016.01	07/10/2015 01:43:40 PM Central Daylight Time					07/13/2015 04:30:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Complete Plan (Cost)	06	18		1			H2461	007	0	2016	State of Minnesota		2	100551	2			2								www.bluecrossmn.com	www.primetherapeutics.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	5		1	07/10/2015	2016.01	07/10/2015 01:44:51 PM Central Daylight Time		07/30/2015 08:21:03 AM Central Daylight Time			08/03/2015 12:33:31 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Core Plan with Rx (Cost)	06	18		1			H2461	008	0	2016	State of Minnesota		2	2386	2			2								www.bluecrossmn.com	www.primetherapeutics.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	6		1	07/13/2015	2016.01	07/13/2015 03:31:47 PM Central Daylight Time		07/30/2015 08:21:32 AM Central Daylight Time			08/03/2015 12:33:31 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Choice Plan with Rx (Cost)	06	18		1			H2461	009	0	2016	State of Minnesota		2	16147	2			2								www.bluecrossmn.com	www.primetherapeutics.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	6		1	07/10/2015	2016.01	07/10/2015 01:49:07 PM Central Daylight Time		07/30/2015 08:21:55 AM Central Daylight Time			08/03/2015 12:33:31 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Complete Plan with Rx (Cost)	06	18		1			H2461	010	0	2016	State of Minnesota		2	30118	2			2								www.bluecrossmn.com	www.primetherapeutics.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2462	004	0	1	18	06	H2462_004_0	4		1	07/22/2015	2016.01	07/22/2015 03:54:17 PM Central Daylight Time					07/22/2015 04:20:17 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Basic (Cost)	06	18		1			H2462	004	0	2016	State of Minnesota		2	63	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2	2			
H2462	007	0	1	18	06	H2462_007_0	8		1	07/22/2015	2016.01	07/22/2015 03:59:01 PM Central Daylight Time					07/22/2015 04:22:36 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance (Cost)	06	18		1			H2462	007	0	2016	State of Minnesota		2	784	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2	2			
H2462	008	0	1	18	06	H2462_008_0	5		1	07/22/2015	2016.01	07/22/2015 03:59:10 PM Central Daylight Time		07/30/2015 11:03:30 AM Central Daylight Time			07/31/2015 04:20:35 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance with Rx (Cost)	06	18		1			H2462	008	0	2016	State of Minnesota		2		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2	2			
H2462	010	0	1	18	06	H2462_010_0	6		1	07/22/2015	2016.01	07/22/2015 03:56:30 PM Central Daylight Time					07/22/2015 04:26:51 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Ultimate (Cost)	06	18		1			H2462	010	0	2016	State of Minnesota		2	1267	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2	2			
H2462	011	0	1	18	06	H2462_011_0	5		1	07/22/2015	2016.01	07/22/2015 03:56:24 PM Central Daylight Time		07/30/2015 11:10:46 AM Central Daylight Time			07/31/2015 04:24:25 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Ultimate with Rx (Cost)	06	18		1			H2462	011	0	2016	State of Minnesota		2		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2	2			
H2462	012	0	1	18	06	H2462_012_0	5		1	07/22/2015	2016.01	07/22/2015 03:57:04 PM Central Daylight Time		07/30/2015 11:12:04 AM Central Daylight Time			07/31/2015 04:26:57 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Ultimate with Enhanced Rx (Cost)	06	18		1			H2462	012	0	2016	State of Minnesota		2		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2	2			
H2462	015	0	1	18	06	H2462_015_0	4		1	07/22/2015	2016.01	07/22/2015 03:57:26 PM Central Daylight Time					07/22/2015 04:34:03 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Wisconsin Freedom Basic (Cost)	06	18		1			H2462	015	0	2016	Western Wisconsin		2	18	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2	2			
H2462	016	0	1	18	06	H2462_016_0	4		1	07/22/2015	2016.01	07/22/2015 03:57:50 PM Central Daylight Time					07/22/2015 04:36:17 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Wisconsin Freedom Balance (Cost)	06	18		1			H2462	016	0	2016	Western Wisconsin		2	1	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2	2			
H2462	017	0	1	18	06	H2462_017_0	5		1	07/22/2015	2016.01	07/22/2015 03:58:13 PM Central Daylight Time		07/30/2015 11:17:24 AM Central Daylight Time			07/31/2015 04:29:17 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Wisconsin Freedom Balance with Rx (Cost)	06	18		1			H2462	017	0	2016	Western Wisconsin		2		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2	2			
H2462	018	0	1	18	06	H2462_018_0	5		1	07/22/2015	2016.01	07/22/2015 03:58:33 PM Central Daylight Time					07/22/2015 04:40:18 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital (Cost)	06	18		1			H2462	018	0	2016	State of Minnesota		2	843	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2	2			
H2462	019	0	1	18	06	H2462_019_0	4		1	07/22/2015	2016.01	07/22/2015 03:58:50 PM Central Daylight Time		07/30/2015 11:13:46 AM Central Daylight Time			07/31/2015 04:31:15 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital with Rx (Cost)	06	18		1			H2462	019	0	2016	State of Minnesota		2		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2	2			
H2462	801	0	1	18	06	H2462_801_0	1		1	05/21/2015	2016.01	05/21/2015 10:55:21 AM Central Daylight Time					05/21/2015 12:02:25 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Calendar Year (Cost)	06	18		1			H2462	801	0	2016	State of MN Western Wisconsin		1		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060													2			
H2462	802	0	1	18	06	H2462_802_0	2		1	05/21/2015	2016.01	05/21/2015 10:56:02 AM Central Daylight Time					05/21/2015 12:04:21 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Non-Calendar Year (Cost)	06	18		1			H2462	802	0	2016	State of MN Western Wisconsin		1		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060													2			
H2470	001	0	1	01	01	H2470_001_0	4	2	1	08/03/2015	2016.01	08/03/2015 09:43:55 AM Eastern Daylight Time	07/31/2015 01:25:16 PM Eastern Daylight Time	07/31/2015 01:40:16 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON HEALTH WEINBERG, INC	Fallon Health Weinberg	www.fallonweinberg.org	Fallon Health Weinberg (HMO SNP)	01	01		1			H2470	001	0	2016	Erie and Niagara Counties		2	366	2			1	3		1	4			www.fallonweinberg.org	www.fallonweinberg.org	www.fallonweinberg.org	(855)561-7247		(855)561-7247		(855)561-7248		(855)561-7248		(855)561-7247		(855)561-7247		(855)561-7248		(855)561-7248		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2486	003	0	1	01	01	H2486_003_0	3		1	07/08/2015	2016.01	07/08/2015 12:42:48 PM Eastern Daylight Time	08/03/2015 11:21:55 AM Eastern Daylight Time	07/30/2015 11:44:10 AM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana Medical Plan of Utah, Inc.	www.humana-medicare.com	Humana Gold Plus H2486-003 (HMO)	01	01		1			H2486	003	0	2016	Davis, Salt Lake, Utah and Weber counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/11/2015	2016.01	05/11/2015 02:09:49 PM Eastern Daylight Time	05/29/2015 08:10:12 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana Medical Plan of Utah, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2486	801	0	2016	Select counties in Utah		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2486	802	0	1	01	01	H2486_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:10:53 PM Eastern Daylight Time	05/29/2015 08:16:29 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana Medical Plan of Utah, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2486	802	0	2016	Select counties in Utah		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2491	002	0	1	02	01	H2491_002_0	5		1	08/05/2015	2016.01	08/05/2015 06:29:29 AM Eastern Daylight Time	08/05/2015 09:42:48 AM Eastern Daylight Time	08/03/2015 03:53:34 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	'Ohana Health Plan	www.ohanahealthplan.com/medicare	'Ohana Value (HMO-POS)	01	02		1			H2491	002	0	2016	Honolulu County		2	1143	2			2							www.ohanahealthplan.com/medicare	www.ohanahealthplan.com/medicare	www.ohanahealthplan.com/medicare	(888)505-1201		(888)505-1201		(800)265-8171		(800)265-8171		(888)505-1201		(888)505-1201		(877)231-2632		(877)231-2632		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H2491	004	0	1	01	01	H2491_004_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:09:48 PM Eastern Daylight Time	08/03/2015 01:43:02 PM Eastern Daylight Time	08/03/2015 03:54:02 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	'Ohana Health Plan	www.ohanahealthplan.com/medicare	'Ohana Liberty (HMO SNP)	01	01		1			H2491	004	0	2016	Hawaii, Honolulu, Kauai, Maui Counties		2	6988	2			1	3		1	5			www.ohanahealthplan.com/medicare	www.ohanahealthplan.com/medicare	www.ohanahealthplan.com/medicare	(877)457-7621		(877)457-7621		(800)265-8171		(800)265-8171		(877)457-7621		(877)457-7621		(877)231-2632		(877)231-2632		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H2506	001	0	1	48	05	H2506_001_0	7		1	08/26/2015	2016.01	08/26/2015 03:34:18 PM Central Daylight Time					08/26/2015 03:40:24 PM Central Daylight Time	AETNA BETTER HEALTH, INC. (IL)	Aetna Better Health Premier Plan	www.aetnabetterhealth.com/illinois	Aetna Better Health Premier Plan (Medicare-Medicaid Plan)	05	48		1			H2506	001	0	2016	Illinois		2	7000	2			2							www.aetnabetterhealth.com/illinois	www.aetnabetterhealth.com/illinois	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)-		2					2					2				
H2531	001	0	1	48	05	H2531_001_0	4		1	08/14/2015	2016.01	08/14/2015 12:11:17 PM US Mountain Standard Time					08/14/2015 02:52:14 PM US Mountain Standard 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	2016	UnitedHealthcare Community Plan MMP Plan Regions		2		2			2							www.uhccommunityplan.com	www.uhccommunityplan.com	www.optumrx.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)-		2					2					2				
H2533	001	0	1	48	05	H2533_001_0	4		1	06/30/2015	2016.01	06/30/2015 12:22:21 PM Pacific Daylight Time					06/30/2015 02:04:24 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	2016	South Carolina Statewide		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)-		2					2					2				
H2537	001	0	1	20	08	H2537_001_0	1		1	05/20/2015	2016.01	05/20/2015 03:14:41 PM Eastern Daylight Time		05/19/2015 11:17:20 AM Eastern Daylight Time			05/20/2015 03:17:16 PM Eastern Daylight Time	LIFE LUTHERAN SERVICES, INC.	LIFE Lutheran Services, Inc.	www.spiritrustlutheranlife.org	LIFE Lutheran - Dual (PACE)	08	20		1			H2537	001	0	2016	Franklin, Cumberland Counties		2		2			2								www.lifelutheranservices.org	www.norlandavenuepharmacy.com									(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433										(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433																
H2537	002	0	1	20	08	H2537_002_0	1		1	05/20/2015	2016.01	05/20/2015 03:15:19 PM Eastern Daylight Time		05/19/2015 11:17:20 AM Eastern Daylight Time			05/20/2015 03:17:16 PM Eastern Daylight Time	LIFE LUTHERAN SERVICES, INC.	LIFE Lutheran Services, Inc.	www.spiritrustlutheranlife.org	LIFE Lutheran - Medicare Only (PACE)	08	20		1			H2537	002	0	2016	Franklin, Cumberland Counties		2		2			2								www.lifelutheranservices.org	www.norlandavenuepharmacy.com									(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433										(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433																
H2563	001	0	1	01	01	H2563_001_0	10		1	08/10/2015	2016.01	08/10/2015 01:32:29 PM Eastern Daylight Time	08/10/2015 01:05:25 PM Eastern Daylight Time	08/04/2015 05:36:27 PM Eastern Daylight Time			08/10/2015 01:37:25 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Health Plan	www.optimahealth.com/medicare	Optima Medicare Basic (HMO)	01	01		1			H2563	001	0	2016	Tidewater Virginia		2	1423	2			2							http://optimahealth.prismisp.com/	www.optimahealth.com/medicare	www.optimahealth.com	(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		2					2					2	2			
H2563	002	0	1	01	01	H2563_002_0	9		1	08/10/2015	2016.01	08/10/2015 03:16:01 PM Eastern Daylight Time	08/10/2015 03:01:59 PM Eastern Daylight Time	08/04/2015 01:10:41 PM Eastern Daylight Time			08/10/2015 03:16:56 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Health Plan	www.optimahealth.com/medicare	Optima Medicare Enhanced (HMO)	01	01		1			H2563	002	0	2016	Tidewater Virginia		2	1002	2			2							http://optimahealth.prismisp.com/	www.optimahealth.com/medicare	www.optimahealth.com	(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		2					2					2	2			
H2591	001	0	1	04	01	H2591_001_0	5		1	07/01/2015	2016.01	07/01/2015 08:02:05 AM Central Daylight Time	08/03/2015 09:34:37 AM Central Daylight Time	08/02/2015 05:04:08 PM Central Daylight Time			08/04/2015 03:19:31 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare Guide PPO Rx (PPO)	01	04		1			H2591	001	0	2016	Nebraska/Iowa		2	175	2			2							HealthAllianceMedicare.org	HealthAllianceMedicare.org	HealthAllianceMedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		2					2						2			
H2591	801	0	1	04	01	H2591_801_0	2		1	05/14/2015	2016.01	05/14/2015 09:47:15 AM Central Daylight Time	05/30/2015 04:13:02 PM Central Daylight Time				05/31/2015 08:33:54 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (PPO)	01	04		1			H2591	801	0	2016	Health Alliance Medicare		1	56	1	1		2							HealthAllianceMedicare.org	HealthAllianceMedicare.org	HealthAllianceMedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454										(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352										1	2		2		1						2			
H2591	802	0	1	04	01	H2591_802_0	2		1	05/14/2015	2016.01	05/14/2015 09:47:29 AM Central Daylight Time	05/30/2015 04:13:52 PM Central Daylight Time				05/31/2015 08:33:54 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (PPO)	01	04		1			H2591	802	0	2016	Health Alliance Medicare		1	58	1	1		2							HealthAllianceMedicare.org	HealthAllianceMedicare.org	HealthAllianceMedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		1	2		2		1						2			
H2591	803	0	1	04	01	H2591_803_0	2		1	05/14/2015	2016.01	05/14/2015 09:47:43 AM Central Daylight Time	05/30/2015 04:14:41 PM Central Daylight Time				05/31/2015 08:33:54 AM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (non calendar) (PPO)	01	04		1			H2591	803	0	2016	Health Alliance Medicare  (non calendar)		1	77	1	1		2							HealthAllianceMedicare.org	HealthAllianceMedicare.org	HealthAllianceMedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		1	2		2		1						2			
H2593	001	0	1	01	01	H2593_001_0	5		1	08/03/2015	2016.01	08/03/2015 03:38:10 PM Pacific Daylight Time	08/04/2015 02:15:13 PM Pacific Daylight Time	07/29/2015 03:06:10 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H2593	001	0	2016	Pima County		2	5144	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	003	0	1	01	01	H2593_003_0	6		1	08/03/2015	2016.01	08/03/2015 04:18:13 PM Pacific Daylight Time	08/04/2015 02:16:04 PM Pacific Daylight Time	07/29/2015 03:06:28 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Touch (HMO SNP)	01	01		1			H2593	003	0	2016	Pima County		2	893	2			1	1	3	1				www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	005	0	1	01	01	H2593_005_0	5		1	08/03/2015	2016.01	08/03/2015 04:18:39 PM Pacific Daylight Time	08/04/2015 02:16:53 PM Pacific Daylight Time	07/29/2015 03:06:45 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H2593	005	0	2016	Pima County		2	810	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	006	0	1	01	01	H2593_006_0	5		1	08/03/2015	2016.01	08/03/2015 04:19:06 PM Pacific Daylight Time	08/04/2015 02:16:28 PM Pacific Daylight Time	07/29/2015 03:07:03 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Diabetes (HMO SNP)	01	01		1			H2593	006	0	2016	Pima County		2	2583	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	013	0	1	01	01	H2593_013_0	5		1	08/03/2015	2016.01	08/03/2015 04:19:34 PM Pacific Daylight Time	08/04/2015 02:17:16 PM Pacific Daylight Time	07/29/2015 03:07:21 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Heart (HMO SNP)	01	01		1			H2593	013	0	2016	Pima County		2	797	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	018	0	1	01	01	H2593_018_0	5		1	08/03/2015	2016.01	08/03/2015 04:20:04 PM Pacific Daylight Time	08/04/2015 02:15:40 PM Pacific Daylight Time	07/29/2015 03:07:38 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore StartSmart Plus (HMO)	01	01		1			H2593	018	0	2016	Pima County		2	710	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	019	0	1	01	01	H2593_019_0	5		1	08/03/2015	2016.01	08/03/2015 04:20:36 PM Pacific Daylight Time	08/04/2015 02:19:17 PM Pacific Daylight Time	07/29/2015 03:07:56 PM Pacific Daylight Time			08/04/2015 04:58:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	caremore.com	CareMore Touch (HMO SNP)	01	01		1			H2593	019	0	2016	Maricopa County (partial)		2	290	2			1	1	3	1				www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	801	0	1	01	01	H2593_801_0	2		1	05/27/2015	2016.01	05/27/2015 02:01:40 PM Pacific Daylight Time	05/29/2015 07:32:43 PM Pacific Daylight Time				05/30/2015 11:36:54 AM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	caremore.com	CareMore EGWP (HMO)	01	01		1			H2593	801	0	2016	Arizona		1	29	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(855)295-7811		(855)295-7811		(866)622-2820		(866)622-2820										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2593	802	0	1	01	01	H2593_802_0	2		1	05/27/2015	2016.01	05/27/2015 02:04:22 PM Pacific Daylight Time	05/29/2015 07:32:20 PM Pacific Daylight Time				05/30/2015 11:36:54 AM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H2593	802	0	2016	Arizona		1	29	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	804	0	1	01	01	H2593_804_0	2		1	05/19/2015	2016.01	05/19/2015 02:25:39 PM Pacific Daylight Time	05/29/2015 07:33:05 PM Pacific Daylight Time				05/30/2015 11:36:54 AM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H2593	804	0	2016	Arizona		1	10	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2609	001	0	1	20	08	H2609_001_0	2		1	05/21/2015	2016.01	05/21/2015 06:58:19 AM Eastern Daylight Time		05/20/2015 03:10:10 PM Eastern Daylight Time			05/21/2015 07:09:50 AM Eastern Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	www.alexianbrothers.net	Dual Eligibles (PACE)	08	20		1			H2609	001	0	2016	St. Louis City and St. Louis County		2		2			2								None	None									(314)771-5800		(314)771-5800		(314)771-5800		(314)771-5800										(314)771-5800		(314)771-5800		(314)771-5800		(314)771-5800																
H2609	002	0	1	20	08	H2609_002_0	2		1	05/21/2015	2016.01	05/21/2015 06:58:37 AM Eastern Daylight Time		05/20/2015 03:14:50 PM Eastern Daylight Time			05/21/2015 07:09:50 AM Eastern Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	www.alexianbrothers.net	Medicare Only (PACE)	08	20		1			H2609	002	0	2016	St. Louis City and St. Louis County		2		2			2								None	None									(314)771-5800		(314)771-5800		(314)771-5800		(314)771-5800										(314)771-5800		(314)771-5800		(314)771-5800		(314)771-5800																
H2610	005	0	1	01	01	H2610_005_0	7		1	07/31/2015	2016.01	07/31/2015 12:56:50 PM Central Daylight Time	07/30/2015 02:02:59 PM Central Daylight Time	07/30/2015 02:03:40 PM Central Daylight Time			08/03/2015 04:27:15 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	005	0	2016	St. Louis Metropolitan Area		2	48679	2			2							www.essencehealthcare.com	https://www.everythingessence.com/public/drug-formulary.aspx	https://www.everythingessence.com/public/find-a-pharmacy.aspx	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	006	0	1	01	01	H2610_006_0	7		1	07/31/2015	2016.01	07/31/2015 12:57:23 PM Central Daylight Time	07/30/2015 02:06:06 PM Central Daylight Time	07/30/2015 02:06:15 PM Central Daylight Time			08/03/2015 04:27:15 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	01	01		1			H2610	006	0	2016	St. Louis Metropolitan Area		2	2241	2			2							www.essencehealthcare.com	https://www.everythingessence.com/public/drug-formulary.aspx	https://www.everythingessence.com/public/find-a-pharmacy.aspx	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	011	0	1	01	01	H2610_011_0	7		1	07/31/2015	2016.01	07/31/2015 12:57:43 PM Central Daylight Time	07/30/2015 02:08:50 PM Central Daylight Time	07/30/2015 02:10:58 PM Central Daylight Time			08/03/2015 04:27:15 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	011	0	2016	Columbia Metropolitan Area		2	1184	2			2							www.essencehealthcare.com	https://www.everythingessence.com/public/drug-formulary.aspx	https://www.everythingessence.com/public/find-a-pharmacy.aspx	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	014	0	1	02	01	H2610_014_0	7		1	07/31/2015	2016.01	07/31/2015 01:01:55 PM Central Daylight Time	07/30/2015 02:14:11 PM Central Daylight Time	07/30/2015 02:13:53 PM Central Daylight Time			08/03/2015 04:27:15 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Platinum (HMO-POS)	01	02		1			H2610	014	0	2016	St. Louis County and City, St. Charles, Jefferson		2	422	2			2							www.essencehealthcare.com	https://www.everythingessence.com/public/drug-formulary.aspx	https://www.everythingessence.com/public/find-a-pharmacy.aspx	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	015	0	1	01	01	H2610_015_0	7		1	07/31/2015	2016.01	07/31/2015 12:58:04 PM Central Daylight Time	07/30/2015 02:21:50 PM Central Daylight Time	07/30/2015 02:22:04 PM Central Daylight Time			08/03/2015 04:27:15 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	CoxHealth MedicarePlus (HMO)	01	01		1			H2610	015	0	2016	Southwest Missouri		2	7662	2			2							www.essencehealthcare.com	https://www.everythingessence.com/public/drug-formulary.aspx	https://www.everythingessence.com/public/find-a-pharmacy.aspx	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	803	0	1	01	01	H2610_803_0	3		1	05/25/2015	2016.01	05/25/2015 08:09:47 PM Central Daylight Time	07/17/2015 08:47:47 AM Central Daylight Time				07/17/2015 10:16:37 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Employer Group Plan (HMO)	01	01		1			H2610	803	0	2016	MO and IL Service Area		1	50	2			2							www.essencehealthcare.com	https://www.everythingessence.com/public/drug-formulary.aspx	https://www.everythingessence.com/public/find-a-pharmacy.aspx	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;15;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;16b;	1					1	2			
H2610	804	0	1	01	01	H2610_804_0	3		1	05/17/2015	2016.01	05/17/2015 11:51:05 AM Central Daylight Time	07/17/2015 08:46:50 AM Central Daylight Time				07/17/2015 10:16:37 AM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Employer Group Plan non-calendar (HMO)	01	01		1			H2610	804	0	2016	MO and IL Service Area		1	50	2			2							www.essencehealthcare.com	https://www.everythingessence.com/public/drug-formulary.aspx	https://www.everythingessence.com/public/find-a-pharmacy.aspx	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;15;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;16b;	1					1	2			
H2649	004	0	1	01	01	H2649_004_0	3		1	07/08/2015	2016.01	07/08/2015 08:26:36 AM Eastern Daylight Time	08/03/2015 10:43:12 AM Eastern Daylight Time	07/30/2015 11:44:46 AM Eastern Daylight Time			08/04/2015 01:30:38 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-004 (HMO)	01	01		1			H2649	004	0	2016	Kansas City Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	012	0	1	01	01	H2649_012_0	2		1	07/08/2015	2016.01	07/08/2015 08:27:34 AM Eastern Daylight Time	05/25/2015 11:07:44 AM Eastern Daylight Time				07/10/2015 02:13:06 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-012 (HMO)	01	01		1			H2649	012	0	2016	Kansas City Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2649	021	0	1	01	01	H2649_021_0	3		1	07/08/2015	2016.01	07/08/2015 03:01:33 PM Eastern Daylight Time	08/03/2015 10:58:50 AM Eastern Daylight Time	07/29/2015 10:31:46 PM Eastern Daylight Time			08/04/2015 01:33:39 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-021 (HMO)	01	01		1			H2649	021	0	2016	Wichita area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	023	0	1	01	01	H2649_023_0	3		1	07/08/2015	2016.01	07/08/2015 08:27:52 AM Eastern Daylight Time	08/03/2015 10:54:08 AM Eastern Daylight Time	07/30/2015 11:45:22 AM Eastern Daylight Time			08/04/2015 01:33:39 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-023 (HMO)	01	01		1			H2649	023	0	2016	St. Louis Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	024	0	1	01	01	H2649_024_0	4		1	07/08/2015	2016.01	07/08/2015 03:02:22 PM Eastern Daylight Time	08/03/2015 10:57:38 AM Eastern Daylight Time	07/30/2015 11:45:58 AM Eastern Daylight Time			08/04/2015 01:33:39 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-024 (HMO)	01	01		1			H2649	024	0	2016	Kansas City Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	025	0	1	01	01	H2649_025_0	4		1	07/14/2015	2016.01	07/14/2015 10:17:58 AM Eastern Daylight Time	08/03/2015 11:00:59 AM Eastern Daylight Time	07/30/2015 11:46:34 AM Eastern Daylight Time			08/04/2015 01:33:39 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H2649	025	0	2016	Southwest Missouri		2		2			1	4		1		00000000000000000100		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	028	0	1	01	01	H2649_028_0	4	2	1	07/31/2015	2016.01	07/31/2015 01:01:19 PM Eastern Daylight Time	08/03/2015 11:07:39 AM Eastern Daylight Time	07/30/2015 11:47:12 AM Eastern Daylight Time			08/04/2015 01:33:39 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2649-028 (HMO SNP)	01	01		1			H2649	028	0	2016	Select counties in Missouri		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	029	0	1	01	01	H2649_029_0	3		1	07/09/2015	2016.01	07/09/2015 01:41:38 PM Eastern Daylight Time	08/03/2015 04:13:14 PM Eastern Daylight Time	07/29/2015 10:34:44 PM Eastern Daylight Time			08/04/2015 02:01:50 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-029 (HMO)	01	01		1			H2649	029	0	2016	Albuquerque Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b3;	
H2649	030	0	1	01	01	H2649_030_0	3		1	07/08/2015	2016.01	07/08/2015 12:07:35 PM Eastern Daylight Time	07/31/2015 04:04:52 PM Eastern Daylight Time	07/30/2015 11:47:48 AM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-030 (HMO)	01	01		1			H2649	030	0	2016	Maricopa and Pinal (partial) counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	031	0	1	01	01	H2649_031_0	3		1	07/08/2015	2016.01	07/08/2015 11:52:27 AM Eastern Daylight Time	07/31/2015 03:57:26 PM Eastern Daylight Time	07/29/2015 10:35:56 PM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Community HMO (HMO)	01	01		1			H2649	031	0	2016	Pima and Pinal (partial) counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	032	0	1	01	01	H2649_032_0	4		1	07/08/2015	2016.01	07/08/2015 03:06:58 PM Eastern Daylight Time	07/31/2015 04:01:36 PM Eastern Daylight Time	07/30/2015 11:48:24 AM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Community HMO (HMO)	01	01		1			H2649	032	0	2016	Maricopa and Pinal (partial) counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	033	0	1	01	01	H2649_033_0	3		1	07/08/2015	2016.01	07/08/2015 11:53:02 AM Eastern Daylight Time	07/31/2015 04:07:09 PM Eastern Daylight Time	07/29/2015 10:37:06 PM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-033 (HMO)	01	01		1			H2649	033	0	2016	La Paz and Mohave counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	034	0	1	01	01	H2649_034_0	3		1	07/08/2015	2016.01	07/08/2015 11:53:38 AM Eastern Daylight Time	07/31/2015 04:06:38 PM Eastern Daylight Time	07/30/2015 11:49:00 AM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-034 (HMO)	01	01		1			H2649	034	0	2016	Yavapai County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	036	0	1	01	01	H2649_036_0	4		1	07/14/2015	2016.01	07/14/2015 09:57:18 AM Eastern Daylight Time	07/31/2015 04:08:48 PM Eastern Daylight Time	07/30/2015 11:49:36 AM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Community HMO Diabetes and Heart (HMO SNP)	01	01		1			H2649	036	0	2016	Maricopa and Pinal (partial) counties		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	039	0	1	01	01	H2649_039_0	3		1	07/08/2015	2016.01	07/08/2015 11:54:52 AM Eastern Daylight Time	07/31/2015 04:10:04 PM Eastern Daylight Time	07/29/2015 10:38:54 PM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-039 (HMO)	01	01		1			H2649	039	0	2016	La Paz and Mohave counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	042	0	1	01	01	H2649_042_0	3		1	07/08/2015	2016.01	07/08/2015 05:28:30 PM Eastern Daylight Time	08/03/2015 04:13:43 PM Eastern Daylight Time	07/30/2015 11:50:12 AM Eastern Daylight Time			08/04/2015 02:01:50 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-042 (HMO)	01	01		1			H2649	042	0	2016	Colorado's I-25 Corridor Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b3;	
H2649	043	0	1	01	01	H2649_043_0	3		1	07/09/2015	2016.01	07/09/2015 01:41:56 PM Eastern Daylight Time	08/03/2015 04:15:17 PM Eastern Daylight Time	07/30/2015 11:50:50 AM Eastern Daylight Time			08/04/2015 02:01:50 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-043 (HMO)	01	01		1			H2649	043	0	2016	Colorado's I-25 Corridor Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b3;	
H2649	045	0	1	01	01	H2649_045_0	3		1	07/08/2015	2016.01	07/08/2015 03:04:44 PM Eastern Daylight Time	07/31/2015 04:46:50 PM Eastern Daylight Time	07/30/2015 11:51:26 AM Eastern Daylight Time			08/04/2015 01:48:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-045 (HMO)	01	01		1			H2649	045	0	2016	Corpus Christi Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	046	0	1	01	01	H2649_046_0	3		1	07/08/2015	2016.01	07/08/2015 03:05:49 PM Eastern Daylight Time	07/31/2015 04:44:12 PM Eastern Daylight Time	07/30/2015 11:52:02 AM Eastern Daylight Time			08/04/2015 01:48:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-046 (HMO)	01	01		1			H2649	046	0	2016	San Antonio Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	047	0	1	01	01	H2649_047_0	3		1	07/08/2015	2016.01	07/08/2015 03:06:43 PM Eastern Daylight Time	07/31/2015 04:54:59 PM Eastern Daylight Time	07/30/2015 11:52:38 AM Eastern Daylight Time			08/04/2015 01:48:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-047 (HMO)	01	01		1			H2649	047	0	2016	Dallas Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	048	0	1	01	01	H2649_048_0	4	2	1	07/20/2015	2016.01	07/20/2015 04:06:17 PM Eastern Daylight Time	08/03/2015 03:17:04 PM Eastern Daylight Time	07/30/2015 11:53:16 AM Eastern Daylight Time			08/04/2015 01:48:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2649-048 (HMO SNP)	01	01		1			H2649	048	0	2016	Select Counties in Texas		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	049	0	1	01	01	H2649_049_0	3		1	07/08/2015	2016.01	07/08/2015 03:07:35 PM Eastern Daylight Time	07/31/2015 04:53:04 PM Eastern Daylight Time	07/30/2015 11:53:52 AM Eastern Daylight Time			08/04/2015 01:48:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-049 (HMO)	01	01		1			H2649	049	0	2016	El Paso County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	050	0	1	01	01	H2649_050_0	3	2	1	07/31/2015	2016.01	07/31/2015 04:46:08 PM Eastern Daylight Time	08/03/2015 03:15:45 PM Eastern Daylight Time	07/30/2015 11:54:28 AM Eastern Daylight Time			08/04/2015 01:51:43 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2649-050 (HMO SNP)	01	01		1			H2649	050	0	2016	Corpus Christi/San Antonio area		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	051	0	1	01	01	H2649_051_0	3		1	07/08/2015	2016.01	07/08/2015 03:08:26 PM Eastern Daylight Time	07/31/2015 04:50:31 PM Eastern Daylight Time	07/30/2015 11:55:04 AM Eastern Daylight Time			08/04/2015 01:51:43 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-051 (HMO)	01	01		1			H2649	051	0	2016	Hays, Travis and Williamson		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	052	0	1	01	01	H2649_052_0	3		1	07/08/2015	2016.01	07/08/2015 03:10:04 PM Eastern Daylight Time	07/31/2015 04:51:10 PM Eastern Daylight Time	07/30/2015 11:55:40 AM Eastern Daylight Time			08/04/2015 01:51:43 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-052 (HMO)	01	01		1			H2649	052	0	2016	Houston Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	053	0	1	01	01	H2649_053_0	4		1	07/14/2015	2016.01	07/14/2015 10:18:17 AM Eastern Daylight Time	07/31/2015 04:51:49 PM Eastern Daylight Time	07/30/2015 11:56:16 AM Eastern Daylight Time			08/04/2015 01:51:43 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H2649	053	0	2016	Corpus Christi Metro Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	054	0	1	01	01	H2649_054_0	4		1	07/14/2015	2016.01	07/14/2015 10:18:28 AM Eastern Daylight Time	07/31/2015 04:52:28 PM Eastern Daylight Time	07/30/2015 11:56:52 AM Eastern Daylight Time			08/04/2015 01:51:43 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H2649	054	0	2016	San Antonio Metro Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	055	0	1	01	01	H2649_055_0	3		1	07/08/2015	2016.01	07/08/2015 09:59:18 AM Eastern Daylight Time	07/31/2015 04:54:23 PM Eastern Daylight Time	07/29/2015 10:46:36 PM Eastern Daylight Time			08/04/2015 01:51:43 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-055 (HMO)	01	01		1			H2649	055	0	2016	Select Counties in Texas		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	056	0	1	02	01	H2649_056_0	9		1	08/10/2015	2016.01	08/10/2015 09:03:43 AM Eastern Daylight Time		07/29/2015 10:47:12 PM Eastern Daylight Time		08/03/2015 12:49:24 PM Eastern Daylight Time	08/10/2015 12:28:04 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Kidney Care (HMO-POS SNP)	01	02		1			H2649	056	0	2016	Houston Metro Area		2		2			1	4		1		00000000100000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	059	1	1	01	01	H2649_059_1	3		1	07/09/2015	2016.01	07/09/2015 01:43:37 PM Eastern Daylight Time	08/03/2015 11:14:58 AM Eastern Daylight Time	07/30/2015 11:57:28 AM Eastern Daylight Time			08/04/2015 01:36:39 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-059 (HMO)	01	01		1			H2649	059	1	2016	Southwest Missouri	Southwest Missouri	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	059	2	1	01	01	H2649_059_2	3		1	07/09/2015	2016.01	07/09/2015 01:43:52 PM Eastern Daylight Time	08/03/2015 11:15:52 AM Eastern Daylight Time	07/30/2015 11:58:06 AM Eastern Daylight Time			08/04/2015 01:36:39 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-059 (HMO)	01	01		1			H2649	059	2	2016	Southwest Missouri	Southwest Missouri	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	060	0	1	02	01	H2649_060_0	9		1	08/10/2015	2016.01	08/10/2015 09:58:00 AM Eastern Daylight Time		07/29/2015 10:48:58 PM Eastern Daylight Time		08/05/2015 11:38:52 AM Eastern Daylight Time	08/10/2015 12:32:01 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Kidney Care (HMO-POS SNP)	01	02		1			H2649	060	0	2016	Denver/Colorado Springs Metro Area		2		2			1	4		1		00000000100000000000		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2649	801	0	1	01	01	H2649_801_0	1		1	05/11/2015	2016.01	05/11/2015 02:11:58 PM Eastern Daylight Time	05/29/2015 08:08:48 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	801	0	2016	Select counties in Kansas City Metro area		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2649	802	0	1	01	01	H2649_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:13:02 PM Eastern Daylight Time	05/29/2015 08:16:57 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	802	0	2016	Select counties in Kansas City Metro area		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2649	814	0	1	01	01	H2649_814_0	2		1	05/11/2015	2016.01	05/11/2015 02:16:17 PM Eastern Daylight Time	07/22/2015 03:05:41 PM Eastern Daylight Time				07/24/2015 04:26:28 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	814	0	2016	Multi-State		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2649	815	0	1	01	01	H2649_815_0	1		1	05/11/2015	2016.01	05/11/2015 02:17:22 PM Eastern Daylight Time	05/29/2015 08:28:51 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	815	0	2016	Multi-State		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2649	818	0	1	01	01	H2649_818_0	1		1	05/29/2015	2016.01	05/29/2015 10:13:07 AM Eastern Daylight Time	05/29/2015 08:31:20 AM Eastern Daylight Time				05/29/2015 12:44:24 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	818	0	2016	Bexar County		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2654	010	0	1	01	01	H2654_010_0	3		1	08/03/2015	2016.01	08/03/2015 09:53:53 AM Central Daylight Time	07/31/2015 12:26:48 PM Central Daylight Time	07/30/2015 09:32:18 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2654	010	0	2016	Springfield, Missouri Area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2654	013	0	1	01	01	H2654_013_0	4		1	07/31/2015	2016.01	07/31/2015 09:59:56 AM Central Daylight Time	07/31/2015 12:27:11 PM Central Daylight Time	07/30/2015 09:32:34 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2654	013	0	2016	Select counties in Illinois and Missouri		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2654	033	0	1	01	01	H2654_033_0	3		1	07/31/2015	2016.01	07/31/2015 10:19:17 AM Central Daylight Time	07/31/2015 12:27:34 PM Central Daylight Time	07/30/2015 09:32:51 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H2654	033	0	2016	DuPage county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2654	034	0	1	01	01	H2654_034_0	3		1	07/31/2015	2016.01	07/31/2015 10:21:04 AM Central Daylight Time	07/31/2015 12:27:57 PM Central Daylight Time	07/30/2015 09:33:08 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2654	034	0	2016	Chicago Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2654	035	0	1	01	01	H2654_035_0	3		1	08/03/2015	2016.01	08/03/2015 09:54:04 AM Central Daylight Time	07/31/2015 12:28:21 PM Central Daylight Time	07/30/2015 09:33:24 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2654	035	0	2016	Chicago Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2654	036	0	1	01	01	H2654_036_0	3		1	08/03/2015	2016.01	08/03/2015 09:55:05 AM Central Daylight Time	07/31/2015 12:28:44 PM Central Daylight Time	07/30/2015 09:33:39 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Access (HMO)	01	01		1			H2654	036	0	2016	Chicago Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2654	037	0	1	01	01	H2654_037_0	3		1	07/31/2015	2016.01	07/31/2015 10:29:42 AM Central Daylight Time	07/31/2015 12:29:08 PM Central Daylight Time	07/30/2015 09:33:55 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Access (HMO)	01	01		1			H2654	037	0	2016	McLean county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2654	038	0	1	01	01	H2654_038_0	3		1	07/31/2015	2016.01	07/31/2015 10:29:31 AM Central Daylight Time	07/31/2015 12:29:32 PM Central Daylight Time	07/30/2015 09:34:11 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H2654	038	0	2016	Select counties in MO/KS		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2654	039	0	1	01	01	H2654_039_0	3		1	07/31/2015	2016.01	07/31/2015 10:31:39 AM Central Daylight Time	07/31/2015 12:29:56 PM Central Daylight Time	07/30/2015 09:34:27 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H2654	039	0	2016	Kansas City area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2654	040	0	1	01	01	H2654_040_0	3		1	07/31/2015	2016.01	07/31/2015 10:33:06 AM Central Daylight Time	07/31/2015 12:30:19 PM Central Daylight Time	07/30/2015 09:34:44 AM Central Daylight Time			08/03/2015 04:39:06 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H2654	040	0	2016	Boone and Callaway 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	2			
H2654	041	0	1	02	01	H2654_041_0	3		1	05/30/2015	2016.01	05/30/2015 11:37:35 AM Central Daylight Time	07/31/2015 12:30:43 PM Central Daylight Time	07/30/2015 09:35:03 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H2654	041	0	2016	Cook, DuPage, Kane and Lake counties		2		2			1	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			
H2654	801	0	1	01	01	H2654_801_0	1		1	04/13/2015	2016.01	04/13/2015 01:22:46 PM Central Daylight Time	05/29/2015 04:08:14 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	801	0	2016	St Louis Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H2654	802	0	1	01	01	H2654_802_0	1		1	04/13/2015	2016.01	04/13/2015 01:24:15 PM Central Daylight Time	05/29/2015 04:08:39 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	802	0	2016	St Louis Area Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H2654	803	0	1	01	01	H2654_803_0	1		1	04/13/2015	2016.01	04/13/2015 01:25:01 PM Central Daylight Time	05/29/2015 04:09:03 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	803	0	2016	Springfield Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H2654	804	0	1	01	01	H2654_804_0	1		1	04/13/2015	2016.01	04/13/2015 01:26:09 PM Central Daylight Time	05/29/2015 04:09:28 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	804	0	2016	Springfield Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H2654	805	0	1	01	01	H2654_805_0	1		1	04/13/2015	2016.01	04/13/2015 01:27:32 PM Central Daylight Time	05/29/2015 04:09:52 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	805	0	2016	St. Louis Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H2654	807	0	1	01	01	H2654_807_0	1		1	04/13/2015	2016.01	04/13/2015 01:28:12 PM Central Daylight Time	05/29/2015 04:10:16 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	807	0	2016	Springfield Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H2663	002	0	1	01	01	H2663_002_0	6		1	07/31/2015	2016.01	07/31/2015 07:44:18 PM Central Daylight Time	07/31/2015 07:37:39 PM Central Daylight Time	07/29/2015 04:06:29 PM Central Daylight Time			08/02/2015 11:24:34 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Advantra Option 2 (HMO)	01	01		1			H2663	002	0	2016	St. Louis MO Metro Area		2	373	2			2							www.providerdirectory.coventry-medicare.com	www.moformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(866)291-8628		(866)291-8628		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	005	0	1	01	01	H2663_005_0	7		1	07/31/2015	2016.01	07/31/2015 07:23:37 PM Central Daylight Time	08/01/2015 08:47:11 PM Central Daylight Time	07/29/2015 04:06:47 PM Central Daylight Time			08/02/2015 11:24:34 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Gold Advantage (HMO)	01	01		1			H2663	005	0	2016	St. Louis MO Metro Area		2	373	2			2							www.providerdirectory.coventry-medicare.com	www.moformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(866)291-8628		(866)291-8628		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2663	006	0	1	02	01	H2663_006_0	6		1	07/31/2015	2016.01	07/31/2015 07:24:43 PM Central Daylight Time	07/31/2015 07:38:39 PM Central Daylight Time	07/29/2015 04:07:06 PM Central Daylight Time			08/02/2015 11:24:34 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Advantra Option 1 (HMO-POS)	01	02		1			H2663	006	0	2016	St. Louis MO Metro Area		2	4739	2			2							www.providerdirectory.coventry-medicare.com	www.moformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(866)291-8628		(866)291-8628		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	015	0	1	02	01	H2663_015_0	7		1	07/31/2015	2016.01	07/31/2015 08:22:01 PM Central Daylight Time	08/04/2015 05:33:02 PM Eastern Daylight Time	07/29/2015 05:07:25 PM Eastern Daylight Time			08/04/2015 06:23:00 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Coventry Total Care (HMO-POS)	01	02		1			H2663	015	0	2016	St. Louis MO Metro Area		2	4739	2			2							www.providerdirectory.coventry-medicare.com	www.moformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(866)291-8628		(866)291-8628		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	016	0	1	01	01	H2663_016_0	5		1	07/31/2015	2016.01	07/31/2015 07:26:24 PM Central Daylight Time	07/31/2015 06:46:32 PM Central Daylight Time	07/29/2015 04:07:44 PM Central Daylight Time			08/02/2015 11:24:34 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcillinoismedicare.com	Coventry Total Care (HMO)	01	01		1			H2663	016	0	2016	Boone, Winnebago Illinois		2	1348	2			2							www.providerdirectory.coventry-medicare.com	www.ilformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(800)707-9372		(800)707-9372		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	017	0	1	01	01	H2663_017_0	5		1	07/31/2015	2016.01	07/31/2015 07:28:59 PM Central Daylight Time	07/31/2015 07:39:50 PM Central Daylight Time	07/29/2015 04:08:02 PM Central Daylight Time			08/02/2015 11:24:34 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcillinoismedicare.com	Coventry Total Care (HMO)	01	01		1			H2663	017	0	2016	Peoria, Tazewell Illinois		2	1348	2			2							www.providerdirectory.coventry-medicare.com	www.ilformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(800)707-9372		(800)707-9372		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	802	0	1	01	01	H2663_802_0	2		1	05/05/2015	2016.01	05/05/2015 04:48:25 PM Central Daylight Time	07/16/2015 04:29:32 PM Central Daylight Time				07/16/2015 05:00:49 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Employer Group Calendar Rx (HMO)	01	01		1			H2663	802	0	2016	St. Louis MO Metro Area - Employer Group		1	0	2			2							www.providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551		(866)291-8628		(866)291-8628		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H2663	805	0	1	01	01	H2663_805_0	2		1	04/17/2015	2016.01	04/17/2015 12:45:44 PM Central Daylight Time	07/16/2015 04:29:32 PM Central Daylight Time				07/16/2015 05:00:49 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Employer Group Calendar No Rx (HMO)	01	01		1			H2663	805	0	2016	St. Louis MO Metro Area - Employer Group		1	0	2			2							www.providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H2663	810	0	1	01	01	H2663_810_0	1		1	04/17/2015	2016.01	04/17/2015 12:45:58 PM Central Daylight Time	05/27/2015 07:53:08 PM Central Daylight Time				05/28/2015 11:06:18 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	http://www.aetna-coventryretiree.com/	Employer Group SOI w/Rx (HMO)	01	01		1			H2663	810	0	2016	Illinois		1	0	2			2							http://www.aetna-coventryretiree.com/	http://www.aetna-coventryretiree.com/	http://www.aetna-coventryretiree.com/	(855)223-4807		(855)223-4807		(855)338-9551		(855)338-9551		(866)295-6225		(866)295-6225		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H2667	001	0	1	01	01	H2667_001_0	4		1	07/31/2015	2016.01	07/31/2015 05:53:06 PM Central Daylight Time	08/02/2015 04:48:41 PM Central Daylight Time	07/29/2015 04:08:21 PM Central Daylight Time			08/02/2015 10:23:49 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Advantage (HMO)	01	01		1			H2667	001	0	2016	Southwest Missouri		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2667	012	0	1	01	01	H2667_012_0	3		1	07/16/2015	2016.01	07/16/2015 12:52:30 PM Central Daylight Time	07/15/2015 04:34:12 PM Central Daylight Time				07/16/2015 05:16:33 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Advantage (no drug) (HMO)	01	01		1			H2667	012	0	2016	Southwest Missouri		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2667	017	0	1	02	01	H2667_017_0	6		1	07/31/2015	2016.01	07/31/2015 04:30:40 PM Central Daylight Time	08/02/2015 04:51:18 PM Central Daylight Time	07/29/2015 04:08:40 PM Central Daylight Time			08/02/2015 10:23:49 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Advantage Plus (HMO-POS)	01	02		1			H2667	017	0	2016	Southwest Missouri		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2667	020	0	1	01	01	H2667_020_0	3		1	07/31/2015	2016.01	07/31/2015 05:55:22 PM Central Daylight Time	08/02/2015 04:24:51 PM Central Daylight Time	07/29/2015 04:08:59 PM Central Daylight Time			08/02/2015 10:23:49 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Total Care (HMO)	01	01		1			H2667	020	0	2016	Oklahoma		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2667	021	0	1	01	01	H2667_021_0	1		1	05/23/2015	2016.01	05/23/2015 08:43:53 AM Central Daylight Time	05/28/2015 01:51:04 PM Central Daylight Time				05/28/2015 04:53:45 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Total Care (no drug) (HMO)	01	01		1			H2667	021	0	2016	Oklahoma		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	pharmacylocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2667	807	0	1	01	01	H2667_807_0	2		1	04/17/2015	2016.01	04/17/2015 12:46:16 PM Central Daylight Time	07/16/2015 04:29:33 PM Central Daylight Time				07/16/2015 05:16:33 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Employer Group With RX CY (HMO)	01	01		1			H2667	807	0	2016	Southwest Missouri		1	0	2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H2667	808	0	1	01	01	H2667_808_0	2		1	04/17/2015	2016.01	04/17/2015 12:46:29 PM Central Daylight Time	07/16/2015 04:29:33 PM Central Daylight Time				07/16/2015 05:16:33 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Employer Group no RX CY (HMO)	01	01		1			H2667	808	0	2016	Southwest Missouri		1	0	2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H2672	001	0	1	01	01	H2672_001_0	5		1	08/03/2015	2016.01	08/03/2015 03:02:27 PM Central Daylight Time	08/03/2015 03:33:49 PM Eastern Daylight Time	07/29/2015 05:09:18 PM Eastern Daylight Time			08/03/2015 04:45:59 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Advantage (HMO)	01	01		1			H2672	001	0	2016	Kansas City Metro Area		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2672	008	0	1	01	01	H2672_008_0	5		1	08/02/2015	2016.01	08/02/2015 10:30:32 PM Central Daylight Time	08/02/2015 05:41:49 PM Central Daylight Time	07/29/2015 04:09:36 PM Central Daylight Time			08/02/2015 10:38:30 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Advantage (HMO)	01	01		1			H2672	008	0	2016	Wyandotte County		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2672	009	0	1	01	01	H2672_009_0	5		1	07/31/2015	2016.01	07/31/2015 05:50:52 PM Central Daylight Time	08/02/2015 05:44:25 PM Central Daylight Time	07/29/2015 04:09:55 PM Central Daylight Time			08/02/2015 10:38:30 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Medicare Advantage Total Care (HMO)	01	01		1			H2672	009	0	2016	Wichita Kansas Area		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2672	010	0	1	01	01	H2672_010_0	6		1	08/03/2015	2016.01	08/03/2015 03:36:12 PM Central Daylight Time	08/03/2015 03:34:26 PM Eastern Daylight Time	07/29/2015 05:10:14 PM Eastern Daylight Time			08/03/2015 04:52:38 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Total Care (HMO)	01	01		1			H2672	010	0	2016	NW Arkansas		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2672	017	0	1	01	01	H2672_017_0	3		1	07/07/2015	2016.01	07/07/2015 12:19:33 PM Central Daylight Time	05/28/2015 01:49:30 AM Central Daylight Time				07/14/2015 04:35:01 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Select (no drug) (HMO)	01	01		1			H2672	017	0	2016	Limited counties Missouri and Kansas		2		2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	pharmacylocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2672	018	0	1	01	01	H2672_018_0	6		1	07/14/2015	2016.01	07/14/2015 02:58:50 PM Central Daylight Time	08/02/2015 06:01:38 PM Central Daylight Time	07/29/2015 04:10:33 PM Central Daylight Time			08/02/2015 10:38:30 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Connect Plus (HMO)	01	01		1			H2672	018	0	2016	Partial State AR, KS, MO, OK		2	500	2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)338-9551		(855)338-9551		(866)294-9803		(866)294-9803		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2672	801	0	1	01	01	H2672_801_0	2		1	04/17/2015	2016.01	04/17/2015 12:46:49 PM Central Daylight Time	07/16/2015 04:29:56 PM Central Daylight Time				07/16/2015 05:24:30 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Employer Group (HMO)	01	01		1			H2672	801	0	2016	Arkansas, Kansas, Missouri		1	0	2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H2672	803	0	1	01	01	H2672_803_0	1		1	04/17/2015	2016.01	04/17/2015 12:47:18 PM Central Daylight Time	05/28/2015 01:19:37 PM Central Daylight Time				05/28/2015 05:09:50 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Employer Group w/o Rx (HMO)	01	01		1			H2672	803	0	2016	Arkansas, Kansas, Missouri		1	0	2			2							providerdirectory.coventry-medicare.com	KSformulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H2676	001	0	1	04	01	H2676_001_0	5		1	07/21/2015	2016.01	07/21/2015 10:27:53 AM Central Daylight Time	07/31/2015 09:09:16 AM Central Daylight Time	07/30/2015 08:17:38 AM Central Daylight Time			08/04/2015 09:11:10 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (PPO)	01	04		1			H2676	001	0	2016	Select Counties of Texas and Arkansas		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2701	003	0	1	04	01	H2701_003_0	10		1	08/03/2015	2016.01	08/03/2015 01:56:20 PM Mountain Daylight Time	08/04/2015 10:06:46 PM Mountain Daylight Time	08/04/2015 10:06:34 PM Mountain Daylight Time			08/04/2015 10:07:39 PM Mountain Daylight Time	NEW WEST HEALTH SERVICES	New West Health Services	www.newwestmedicare.com	New West Medicare Value (PPO)	01	04		1			H2701	003	0	2016	Selected Counties in Montana		2	13000	2			2							www.newwestmedicare.com	www.newwestmedicare.com	www.newwestmedicare.com	(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2701	006	0	1	04	01	H2701_006_0	10		1	08/03/2015	2016.01	08/03/2015 01:56:40 PM Mountain Daylight Time	08/04/2015 10:29:01 AM Mountain Daylight Time	08/04/2015 10:29:06 AM Mountain Daylight Time			08/04/2015 10:08:57 PM Mountain Daylight Time	NEW WEST HEALTH SERVICES	New West Health Services	www.newwestmedicare.com	New West Medicare Basic (PPO)	01	04		1			H2701	006	0	2016	Selected Counties in Montana		2	6500	2			2							www.newwestmedicare.com	www.newwestmedicare.com	www.newwestmedicare.com	(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2701	806	0	1	04	01	H2701_806_0	5		1	05/29/2015	2016.01	05/29/2015 09:58:19 PM Mountain Daylight Time	07/21/2015 04:21:05 PM Mountain Daylight Time				07/21/2015 05:11:06 PM Mountain Daylight Time	NEW WEST HEALTH SERVICES	New West Health Services	www.newwestmedicare.com	New West Medicare Group Plus (PPO)	01	04		1			H2701	806	0	2016	National		1	700	2			2							www.newwestmedicare.com	www.newwestmedicare.com	www.newwestmedicare.com	(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;10a;11a;11b;15;	2		1						2			
H2701	807	0	1	04	01	H2701_807_0	5		1	04/28/2015	2016.01	04/28/2015 09:43:06 AM Mountain Daylight Time	07/21/2015 04:21:10 PM Mountain Daylight Time				07/21/2015 05:12:52 PM Mountain Daylight Time	NEW WEST HEALTH SERVICES	New West Health Services	www.newwestmedicare.com	New West Medicare Group Plus (PPO)	01	04		1			H2701	807	0	2016	National		1	800	2			2							www.newwestmedicare.com	www.newwestmedicare.com	www.newwestmedicare.com	(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;10a;11a;11b;15;	2		1						2			
H2751	002	0	1	48	05	H2751_002_0	6		1	08/11/2015	2016.01	08/11/2015 05:19:30 PM Eastern Daylight Time					08/11/2015 05:26:42 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare Advocate Complete FIDA	www.fida.wellcareny.com	WellCare Advocate Complete FIDA (Medicare-Medicaid Plan)	05	48		1			H2751	002	0	2016	Ki, Qu, Brx, NY, Ri, Wes, Suf, Na		2	100	2			2							www.fida.wellcareny.com	www.fida.wellcareny.com	www.fida.wellcareny.com	(855)595-2063		(855)595-2063		(877)817-5794		(877)817-5794		(855)595-2063		(855)595-2063		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2				
H2758	002	0	1	01	01	H2758_002_0	11		1	09/18/2015	2016.01	09/18/2015 10:45:45 AM Eastern Daylight Time	07/31/2015 06:22:12 PM Eastern Daylight Time	07/31/2015 02:33:52 PM Eastern Daylight Time			09/23/2015 03:13:15 PM Eastern Daylight Time	BEHEALTHY AMERICA, INC.	BeHealthy America, Inc.	www.behealthyus.com	BlueMedicare Preferred HMO (HMO)	01	01		1			H2758	002	0	2016	Manatee and Sarasota counties		2	3500	2			2							http://www.behealthyus.com/Providers.html	http://www.behealthyus.com/Resources.html	http://www.behealthyus.com/Resources.html	(855)522-2870		(941)556-0770		(855)522-2985		(941)556-0588		(855)522-2871		(941)556-1241		(855)522-2985		(941)556-0588		(855)522-2973		(941)556-0587		(711)-		(711)-		(855)522-2973		(941)556-0587		(711)-		(711)-		2					2					2	2			
H2758	004	0	1	01	01	H2758_004_0	11		1	09/18/2015	2016.01	09/18/2015 10:47:37 AM Eastern Daylight Time	07/31/2015 06:25:04 PM Eastern Daylight Time	07/31/2015 02:34:37 PM Eastern Daylight Time			09/23/2015 03:13:15 PM Eastern Daylight Time	BEHEALTHY AMERICA, INC.	BeHealthy America, Inc.	www.behealthyus.com	BlueMedicare Preferred HMO (HMO)	01	01		1			H2758	004	0	2016	Clay and Duval Counties		2	3000	2			2							www.behealthyus.com/Providers.html	www.behealthyus.com/Resources.html	www.behealthyus.com/Resources.html	(855)522-2870		(941)556-0770		(855)522-2985		(941)556-0588		(855)522-2871		(941)556-1241		(855)522-2985		(941)556-0588		(855)522-2973		(941)556-0587		(711)-		(711)-		(855)522-2973		(941)556-0587		(711)-		(711)-		2					2					2	2			
H2758	005	0	1	01	01	H2758_005_0	12		1	09/18/2015	2016.01	09/18/2015 10:48:08 AM Eastern Daylight Time	07/31/2015 06:23:19 PM Eastern Daylight Time	07/31/2015 02:35:14 PM Eastern Daylight Time			09/23/2015 03:13:15 PM Eastern Daylight Time	BEHEALTHY AMERICA, INC.	BeHealthy America, Inc.	www.behealthyus.com	BlueMedicare Preferred HMO (HMO SNP)	01	01		1			H2758	005	0	2016	Manatee and Sarasota Counties		2	2400	2			1	4		1		00000000000000000010		www.behealthyus.com/Providers.html	www.behealthyus.com/Resources.html	www.behealthyus.com/Resources.html	(855)522-2870		(941)556-0770		(855)522-2985		(941)556-0588		(855)522-2871		(941)556-1241		(855)522-2985		(941)556-0588		(855)522-2973		(941)556-0587		(711)-		(711)-		(855)522-2973		(941)556-0587		(711)-		(711)-		2					2					2	2			
H2773	003	0	1	01	01	H2773_003_0	5		1	08/04/2015	2016.01	08/04/2015 10:17:49 PM Eastern Daylight Time	08/05/2015 09:15:29 PM Eastern Daylight Time	08/05/2015 09:29:44 PM Eastern Daylight Time			08/05/2015 09:51:19 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Health NY - SNP (HMO SNP)	01	01		1			H2773	003	0	2016	Nassau, and Suffolk Counties		2	600	2			1	4		1		00000000000000000010		www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	015	0	1	01	01	H2773_015_0	6		1	08/04/2015	2016.01	08/04/2015 10:18:36 PM Eastern Daylight Time	08/05/2015 09:15:29 PM Eastern Daylight Time	08/05/2015 09:29:44 PM Eastern Daylight Time			08/05/2015 09:51:19 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Platinum Plus NY (HMO)	01	01		1			H2773	015	0	2016	Nassau, Queens, Staten Island and Suffolk Counties		2	140	2			2							www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	017	0	1	01	01	H2773_017_0	6		1	08/12/2015	2016.01	08/12/2015 02:22:23 PM Eastern Daylight Time	08/05/2015 09:15:30 PM Eastern Daylight Time	08/12/2015 02:21:17 PM Eastern Daylight Time			08/12/2015 02:24:21 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Health NYC - SNP (HMO SNP)	01	01		1			H2773	017	0	2016	Queens County and Staten Island		2	500	2			1	4		1		00000000000000000010		www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	018	0	1	01	01	H2773_018_0	5	2	1	08/04/2015	2016.01	08/04/2015 10:20:04 PM Eastern Daylight Time	08/05/2015 09:15:30 PM Eastern Daylight Time	08/05/2015 09:29:44 PM Eastern Daylight Time			08/05/2015 09:51:19 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Value One NY - Dual (HMO SNP)	01	01		1			H2773	018	0	2016	Nassau, Queens, Staten Island and Suffolk Counties		2	700	2			1	3		1	2			www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	019	0	1	01	01	H2773_019_0	7		1	08/04/2015	2016.01	08/04/2015 10:21:05 PM Eastern Daylight Time	08/05/2015 09:15:30 PM Eastern Daylight Time	08/05/2015 09:29:44 PM Eastern Daylight Time			08/05/2015 09:51:19 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Silver - NY (HMO)	01	01		1			H2773	019	0	2016	Nassau and Suffolk Counties		2	850	2			2							www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2773	020	0	1	01	01	H2773_020_0	5		1	08/04/2015	2016.01	08/04/2015 10:22:07 PM Eastern Daylight Time	08/05/2015 09:15:31 PM Eastern Daylight Time	08/05/2015 09:29:44 PM Eastern Daylight Time			08/05/2015 09:51:19 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Silver - NY City (HMO)	01	01		1			H2773	020	0	2016	Queens and Staten Island		2	775	2			2							www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2775	082	0	1	04	01	H2775_082_0	6		1	07/10/2015	2016.01	07/10/2015 04:09:48 PM Central Daylight Time	08/03/2015 01:06:24 PM Central Daylight Time	07/31/2015 03:20:35 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 150A (PPO)	01	04		1			H2775	082	0	2016	Select Counties in NY, ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	083	0	1	04	01	H2775_083_0	6		1	07/13/2015	2016.01	07/13/2015 04:56:33 PM Central Daylight Time	08/03/2015 01:15:42 PM Central Daylight Time	07/31/2015 03:21:03 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 150A (PPO)	01	04		1			H2775	083	0	2016	Select Counties in NY, ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	088	0	1	04	01	H2775_088_0	6		1	08/03/2015	2016.01	08/03/2015 01:08:45 PM Central Daylight Time	08/03/2015 09:40:35 AM Central Daylight Time	07/31/2015 03:21:46 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 450B (PPO)	01	04		1			H2775	088	0	2016	Select Counties in NY, ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	089	0	1	04	01	H2775_089_0	6		1	08/03/2015	2016.01	08/03/2015 01:12:03 PM Central Daylight Time	08/04/2015 11:20:56 AM Central Daylight Time	07/31/2015 03:22:25 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 550B (PPO)	01	04		1			H2775	089	0	2016	Select Counties in NY,ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	095	0	1	04	01	H2775_095_0	5		1	07/10/2015	2016.01	07/10/2015 04:10:22 PM Central Daylight Time	06/22/2015 03:51:12 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage 200 (PPO)	01	04		1			H2775	095	0	2016	Select Counties in NY,ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2775	099	0	1	04	01	H2775_099_0	6		1	07/10/2015	2016.01	07/10/2015 04:15:51 PM Central Daylight Time	08/03/2015 12:19:30 PM Central Daylight Time	07/31/2015 03:22:54 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 350A (PPO)	01	04		1			H2775	099	0	2016	Select counties in New York		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	100	0	1	04	01	H2775_100_0	6		1	07/10/2015	2016.01	07/10/2015 04:20:39 PM Central Daylight Time	08/03/2015 02:00:50 PM Central Daylight Time	07/31/2015 03:23:20 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 650B (PPO)	01	04		1			H2775	100	0	2016	Select counties in New York		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	801	0	1	04	01	H2775_801_0	6		1	05/30/2015	2016.01	05/30/2015 12:09:09 PM Central Daylight Time	06/23/2015 05:21:08 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options PPO - MA Group Plan (PPO)	01	04		1			H2775	801	0	2016	National		1		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H2775	802	0	1	04	01	H2775_802_0	6		1	05/30/2015	2016.01	05/30/2015 12:25:27 PM Central Daylight Time	06/23/2015 05:23:58 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options PPO - MAPD Group Plan (PPO)	01	04		1			H2775	802	0	2016	National		1		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H2775	803	0	1	04	01	H2775_803_0	6		1	05/30/2015	2016.01	05/30/2015 12:27:57 PM Central Daylight Time	06/23/2015 05:31:42 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options PPO - MAPD Group Plan - NCY (PPO)	01	04		1			H2775	803	0	2016	National		1		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H2802	001	0	1	01	01	H2802_001_0	3		1	07/31/2015	2016.01	07/31/2015 10:47:55 AM Central Daylight Time	07/31/2015 01:03:08 PM Central Daylight Time	07/30/2015 09:35:20 AM Central Daylight Time			08/03/2015 04:40:36 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2802	001	0	2016	Douglas, Pottawattamie and Sarpy 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	2			
H2802	007	0	1	01	01	H2802_007_0	3		1	07/31/2015	2016.01	07/31/2015 10:48:57 AM Central Daylight Time	07/31/2015 01:03:32 PM Central Daylight Time	07/30/2015 09:35:38 AM Central Daylight Time			08/03/2015 04:40:36 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Profile (HMO)	01	01		1			H2802	007	0	2016	Fort Wayne area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	008	0	1	01	01	H2802_008_0	3		1	07/31/2015	2016.01	07/31/2015 10:51:51 AM Central Daylight Time	07/31/2015 01:03:55 PM Central Daylight Time	07/30/2015 09:35:55 AM Central Daylight Time			08/03/2015 04:40:36 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H2802	008	0	2016	South Bend area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	009	0	1	01	01	H2802_009_0	3		1	07/31/2015	2016.01	07/31/2015 10:53:41 AM Central Daylight Time	07/31/2015 01:04:19 PM Central Daylight Time	07/30/2015 09:36:11 AM Central Daylight Time			08/03/2015 04:40:36 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H2802	009	0	2016	Lafayette area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	010	0	1	01	01	H2802_010_0	3		1	07/31/2015	2016.01	07/31/2015 10:55:18 AM Central Daylight Time	07/31/2015 01:04:42 PM Central Daylight Time	07/30/2015 09:36:28 AM Central Daylight Time			08/03/2015 04:40:36 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H2802	010	0	2016	Marion and surrounding areas		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	011	0	1	01	01	H2802_011_0	3		1	08/03/2015	2016.01	08/03/2015 10:03:26 AM Central Daylight Time	07/31/2015 01:05:06 PM Central Daylight Time	07/30/2015 09:36:46 AM Central Daylight Time			08/03/2015 04:40:36 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H2802	011	0	2016	Brown, Greene and Lawrence 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	2			
H2802	012	0	1	01	01	H2802_012_0	3		1	07/31/2015	2016.01	07/31/2015 10:58:09 AM Central Daylight Time	07/31/2015 01:05:30 PM Central Daylight Time	07/30/2015 09:37:05 AM Central Daylight Time			08/03/2015 04:40:36 PM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H2802	012	0	2016	Evansville area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2815	001	0	1	20	08	H2815_001_0	1		1	05/19/2015	2016.01	05/19/2015 09:41:27 AM Mountain Daylight Time		05/19/2015 09:17:40 AM Mountain Daylight Time			05/19/2015 09:44:01 AM Mountain Daylight Time	VOLUNTEERS OF AMERICA NATIONAL SERVICES	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	08	20		1			H2815	001	0	2016	Senior CommUnity Care of Colorado		2		2			2								www.voa.org	www.voa.org									(888)476-8120		(970)252-0522		(888)476-8120		(970)252-0522										(970)835-4072		(970)252-0522		(970)835-4072		(970)252-0522																
H2815	002	0	1	20	08	H2815_002_0	1		1	05/19/2015	2016.01	05/19/2015 09:42:36 AM Mountain Daylight Time		05/19/2015 09:18:05 AM Mountain Daylight Time			05/19/2015 09:44:01 AM Mountain Daylight Time	VOLUNTEERS OF AMERICA NATIONAL SERVICES	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	08	20		1			H2815	002	0	2016	Senior CommUnity Care of Colorado		2		2			2								www.voa.org	www.voa.org									(888)476-8120		(970)252-0522		(888)476-8120		(970)252-0522										(970)835-4072		(970)252-0522		(970)835-4072		(970)252-0522																
H2816	001	0	1	09	04	H2816_001_0	5		1	07/10/2015	2016.01	07/10/2015 02:22:44 PM Central Daylight Time	06/22/2015 04:00:42 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 100 (PFFS)	04	09	1	1			H2816	001	0	2016	Select counties in NY,ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	002	0	1	09	04	H2816_002_0	5		1	07/10/2015	2016.01	07/10/2015 02:23:03 PM Central Daylight Time	06/22/2015 04:10:23 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 100 (PFFS)	04	09	1	1			H2816	002	0	2016	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	007	0	1	09	04	H2816_007_0	5		1	07/10/2015	2016.01	07/10/2015 02:23:13 PM Central Daylight Time	06/22/2015 04:19:53 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 200 (PFFS)	04	09	1	1			H2816	007	0	2016	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	008	0	1	09	04	H2816_008_0	5		1	07/10/2015	2016.01	07/10/2015 02:23:26 PM Central Daylight Time	06/22/2015 04:30:03 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 200 (PFFS)	04	09	1	1			H2816	008	0	2016	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	013	0	1	09	04	H2816_013_0	6		1	07/10/2015	2016.01	07/10/2015 02:23:38 PM Central Daylight Time	08/03/2015 01:25:49 PM Central Daylight Time	07/31/2015 03:24:11 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier Plus 150A (PFFS)	04	09	1	1			H2816	013	0	2016	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	019	0	1	09	04	H2816_019_0	6		1	08/03/2015	2016.01	08/03/2015 01:14:49 PM Central Daylight Time	08/03/2015 09:59:53 AM Central Daylight Time	07/31/2015 03:24:41 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier Plus 450B (PFFS)	04	09	1	1			H2816	019	0	2016	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	021	0	1	09	04	H2816_021_0	6		1	08/03/2015	2016.01	08/03/2015 01:16:35 PM Central Daylight Time	08/03/2015 10:10:19 AM Central Daylight Time	07/31/2015 03:25:13 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier Plus 450B (PFFS)	04	09	1	1			H2816	021	0	2016	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	027	0	1	09	04	H2816_027_0	6		1	07/13/2015	2016.01	07/13/2015 04:18:46 PM Central Daylight Time	08/03/2015 01:36:22 PM Central Daylight Time	07/31/2015 03:25:45 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier Plus 150A (PFFS)	04	09	1	1			H2816	027	0	2016	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	031	0	1	09	04	H2816_031_0	5		1	07/13/2015	2016.01	07/13/2015 04:18:37 PM Central Daylight Time	06/23/2015 02:16:31 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 300 (PFFS)	04	09	1	1			H2816	031	0	2016	Select counties in NY		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	032	0	1	09	04	H2816_032_0	5		1	07/13/2015	2016.01	07/13/2015 10:20:59 AM Central Daylight Time	06/23/2015 02:26:21 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 500 (PFFS)	04	09	1	1			H2816	032	0	2016	Select counties in NY		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	801	0	1	09	04	H2816_801_0	6		1	05/30/2015	2016.01	05/30/2015 12:12:28 PM Central Daylight Time	06/23/2015 05:43:49 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options PFFS - MA Group Plan (PFFS)	04	09	1	1			H2816	801	0	2016	National		1		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										1					1					1	2			
H2816	802	0	1	09	04	H2816_802_0	6		1	05/30/2015	2016.01	05/30/2015 12:17:12 PM Central Daylight Time	06/23/2015 05:53:20 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options PFFS - MAPD Group Plan (PFFS)	04	09	1	1			H2816	802	0	2016	National		1		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1	2			
H2816	803	0	1	09	04	H2816_803_0	6		1	05/30/2015	2016.01	05/30/2015 12:17:39 PM Central Daylight Time	06/23/2015 06:02:49 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options PFFS - MAPD Group Plan - NCY (PFFS)	04	09	1	1			H2816	803	0	2016	National		1		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1	2			
H2836	801	0	1	04	01	H2836_801_0	4		1	05/29/2015	2016.01	05/29/2015 12:15:51 PM Pacific Daylight Time	05/31/2015 01:15:57 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	2016	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H2836	802	0	1	04	01	H2836_802_0	4		1	05/29/2015	2016.01	05/29/2015 12:15:55 PM Pacific Daylight Time	05/31/2015 01:16:02 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	802	0	2016	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H2836	803	0	1	04	01	H2836_803_0	4		1	05/29/2015	2016.01	05/29/2015 12:16:23 PM Pacific Daylight Time	05/31/2015 01:16:07 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	803	0	2016	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H2879	001	0	1	01	01	H2879_001_0	7	2	1	08/05/2015	2016.01	08/05/2015 03:27:27 PM Pacific Daylight Time	08/04/2015 04:12:58 PM Pacific Daylight Time	07/30/2015 08:57:24 AM Pacific Daylight Time			08/05/2015 04:11:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WISCONSIN	Molina Healthcare of Wisconsin	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H2879	001	0	2016	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			
H2905	001	0	1	04	01	H2905_001_0	2		1	07/31/2015	2016.01	07/31/2015 09:41:30 AM Central Daylight Time	07/31/2015 01:06:43 PM Central Daylight Time	07/30/2015 09:37:21 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Sierra Health and Life Insurance Company, Inc.	www.SierraSpectrumPPO.com	Sierra Spectrum (PPO)	01	04		1			H2905	001	0	2016	Washington County		2		2			2							www.SierraSpectrumPPO.com	www.SierraSpectrumPPO.com	www.SierraSpectrumPPO.com	(877)559-4512		(877)559-4512		(800)555-5757		(800)555-5757		(877)559-4512		(877)559-4512		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2906	005	0	1	04	01	H2906_005_0	11		1	08/05/2015	2016.01	08/05/2015 10:41:21 AM Pacific Daylight Time	08/10/2015 09:52:44 AM Pacific Daylight Time	08/05/2015 02:09:56 PM Pacific Daylight Time			08/10/2015 09:57:35 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Select Plan (PPO)	01	04		1			H2906	005	0	2016	Carson City, Churchill, Douglas, Lyon, Storey - NV		2	385	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2906	006	0	1	04	01	H2906_006_0	10		1	08/04/2015	2016.01	08/04/2015 03:53:14 PM Pacific Daylight Time	08/10/2015 09:52:43 AM Pacific Daylight Time	08/05/2015 02:09:57 PM Pacific Daylight Time			08/10/2015 09:58:47 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Enhanced Plan (PPO)	01	04		1			H2906	006	0	2016	Carson City, Churchill, Douglas, Lyon, Storey - NV		2	1587	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2906	007	0	1	04	01	H2906_007_0	7		1	08/04/2015	2016.01	08/04/2015 03:56:22 PM Pacific Daylight Time	08/05/2015 02:09:58 PM Pacific Daylight Time	08/05/2015 02:09:59 PM Pacific Daylight Time			08/05/2015 02:23:25 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Plan (PPO)	01	04		1			H2906	007	0	2016	Carson City, Churchill, Douglas, Lyon, Storey - NV		2	2227	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2906	008	0	1	04	01	H2906_008_0	4		1	07/23/2015	2016.01	07/23/2015 02:52:01 PM Pacific Daylight Time	06/01/2015 05:03:04 PM Pacific Daylight Time				07/23/2015 03:22:12 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Basic Plan (PPO)	01	04		1			H2906	008	0	2016	Carson City, Churchill, Douglas, Lyon, Storey - NV		2	225	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2906	801	0	1	04	01	H2906_801_0	2		1	05/16/2015	2016.01	05/16/2015 12:36:39 PM Pacific Daylight Time	06/01/2015 05:03:05 PM Pacific Daylight Time				06/01/2015 05:20:59 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Group (PPO)	01	04		1			H2906	801	0	2016	State of Nevada		1	65	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1b;2;3-1;3-2;3-3;6;7e;7g;7h;8b1;8b2;8b3;9a;9b;11a;11b;12;	1	1b;2;6;7e;7g;7h;8b1;8b2;8b3;9a;9b;12;	1						2			
H2926	001	0	1	01	01	H2926_001_0	2	2	1	06/01/2015	2016.01	06/01/2015 06:30:09 PM Central Daylight Time	08/03/2015 02:51:22 PM Central Daylight Time	08/03/2015 05:37:43 PM Central Daylight Time			08/04/2015 05:02:00 PM Central Daylight Time	PRIMEWEST CTRL COUNTY-BASED PURCHASING INTIATIVE	PrimeWest Health	www.primewest.org/Members/PHC_HMO.aspx	Prime Health Complete (HMO SNP)	01	01		1			H2926	001	0	2016	Northern, west central, and southwestern Minnesota		2	357	2			1	3		1	5			www.primewest.org/FindA/Default.aspx	http://www.primewest.org/FindA/Drug.aspx	http://www.primewest.org/FindA/Pharmacy.aspx	(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		1	1	1a;1b;2;5;7b;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;	2		1					1	2			
H2931	002	0	1	01	01	H2931_002_0	3		1	07/31/2015	2016.01	07/31/2015 10:05:41 AM Central Daylight Time	07/31/2015 01:08:07 PM Central Daylight Time	07/30/2015 09:37:37 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	Senior Dimensions Southern Nevada (HMO)	01	01		1			H2931	002	0	2016	Clark and Nye counties		2		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(800)555-5757		(800)555-5757		(800)650-6232		(800)650-6232		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2931	004	0	1	01	01	H2931_004_0	3		1	07/31/2015	2016.01	07/31/2015 09:43:40 AM Central Daylight Time	07/31/2015 01:08:31 PM Central Daylight Time	07/30/2015 09:37:53 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	Senior Dimensions Greater Nevada (HMO)	01	01		1			H2931	004	0	2016	Esmeralda, Lyon, Mineral and portions of Washoe		2		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(800)555-5757		(800)555-5757		(800)650-6232		(800)650-6232		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2931	801	0	1	01	01	H2931_801_0	1		1	04/13/2015	2016.01	04/13/2015 01:30:21 PM Central Daylight Time	05/29/2015 02:57:04 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	Basic Group (with Drug) Coverage (HMO)	01	01		1			H2931	801	0	2016	Counties: Clk, Esmrld, Ny, Lyn, Mnrl, parts of Wsh		1		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H2931	803	0	1	01	01	H2931_803_0	1		1	04/13/2015	2016.01	04/13/2015 01:33:59 PM Central Daylight Time	05/29/2015 02:57:36 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	Basic Group MA Only Coverage (HMO)	01	01		1			H2931	803	0	2016	Counties: Clk, Esmrld, Ny, Lyn, Mnrl, parts of Wsh		1		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H2931	804	0	1	01	01	H2931_804_0	1		1	04/13/2015	2016.01	04/13/2015 01:35:29 PM Central Daylight Time	05/29/2015 02:58:08 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	(NCY) Basic Group (With Drug) Coverage (HMO)	01	01		1			H2931	804	0	2016	Counties: Clk, Esmrld, Ny, Lyn, Mnrl, parts of Wsh		1		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H2936	001	0	1	20	08	H2936_001_0	2		1	05/21/2015	2016.01	05/21/2015 02:21:44 PM Eastern Daylight Time		05/20/2015 05:22:57 PM Eastern Daylight Time			05/21/2015 02:22:36 PM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	http:www.lifecircles-pace.org	LifeCircles (PACE)	08	20		1			H2936	001	0	2016	Muskegon, Ottawa		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	2		1	05/21/2015	2016.01	05/21/2015 02:21:52 PM Eastern Daylight Time		05/20/2015 05:29:13 PM Eastern Daylight Time			05/21/2015 02:22:36 PM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	http:www.lifecircles-pace.org	002 - Medicare Only (PACE)	08	20		1			H2936	002	0	2016	002 - Medicare Only		2		2			2								www.lifecircles-pace.org	www.lifecircles-pace.org									(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686										(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686																
H2937	001	0	1	20	08	H2937_001_0	1		1	05/20/2015	2016.01	05/20/2015 10:24:48 AM Eastern Daylight Time		05/18/2015 02:44:40 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Westmoreland county PACE	www.Seniorlifegreensburg.com	Senior LIFE Greensburg Dual Eligible (PACE)	08	20		1			H2937	001	0	2016	Senior LIFE Westmoreland		2	200	2			2								NA	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2937	002	0	1	20	08	H2937_002_0	1		1	05/20/2015	2016.01	05/20/2015 10:25:08 AM Eastern Daylight Time		05/18/2015 02:44:40 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Westmoreland county PACE	www.Seniorlifegreensburg.com	Senior LIFE Greensburg MC Only (PACE)	08	20		1			H2937	002	0	2016	Senior LIFE Westmoreland MC Only		2	1	2			2								NA	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2941	001	0	1	20	08	H2941_001_0	1		1	05/29/2015	2016.01	05/29/2015 11:47:48 AM Eastern Daylight Time		05/28/2015 02:10:15 PM Eastern Daylight Time			05/29/2015 11:49:32 AM Eastern Daylight Time	SENTARA LIFE CARE CORPORATION, INC	Sentara PACE	www.sentara.com	Sentara Senior Community Care Dual (PACE)	08	20		1			H2941	001	0	2016	Chesapeake, Norfolk, Portsmouth, Suffolk, VA Beach		2		2			2								www.sentara.com	www.sentara.com									(800)736-8272		(757)892-5400		(800)736-8272		(757)892-5400										(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120																
H2941	002	0	1	20	08	H2941_002_0	1		1	05/29/2015	2016.01	05/29/2015 11:48:12 AM Eastern Daylight Time		05/28/2015 02:11:21 PM Eastern Daylight Time			05/29/2015 11:49:32 AM Eastern Daylight Time	SENTARA LIFE CARE CORPORATION, INC	Sentara PACE	www.sentara.com	Sentara Senior Community Care Private (PACE)	08	20		1			H2941	002	0	2016	Chesapeake, Norfolk, Portsmouth, Suffolk, VA Beach		2		2			2								www.sentara.com	www.sentara.com									(800)736-8272		(757)892-5400		(800)736-8272		(757)892-5400										(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120																
H2944	004	0	1	09	04	H2944_004_0	4		1	07/08/2015	2016.01	07/08/2015 12:54:55 PM Eastern Daylight Time	08/04/2015 09:45:16 AM Eastern Daylight Time	07/29/2015 10:49:34 PM Eastern Daylight Time			08/04/2015 01:11:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-004 (PFFS)	04	09	3	1			H2944	004	0	2016	Select Counties in Nebraska		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	013	0	1	09	04	H2944_013_0	3		1	07/08/2015	2016.01	07/08/2015 03:15:58 PM Eastern Daylight Time	08/03/2015 10:55:17 AM Eastern Daylight Time	07/29/2015 10:50:10 PM Eastern Daylight Time			08/04/2015 12:55:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-013 (PFFS)	04	09	3	1			H2944	013	0	2016	Select Counties in KS, MO and OK		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	078	0	1	09	04	H2944_078_0	3		1	07/09/2015	2016.01	07/09/2015 03:39:42 PM Eastern Daylight Time	07/31/2015 06:02:40 PM Eastern Daylight Time	07/29/2015 10:50:44 PM Eastern Daylight Time			08/04/2015 01:46:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-078 (PFFS)	04	09	3	1			H2944	078	0	2016	Select Counties in Virginia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	114	0	1	09	04	H2944_114_0	3		1	07/08/2015	2016.01	07/08/2015 02:54:55 PM Eastern Daylight Time	07/31/2015 04:00:32 PM Eastern Daylight Time	07/29/2015 10:51:50 PM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-114 (PFFS)	04	09	3	1			H2944	114	0	2016	Select Counties in Georgia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	124	0	1	09	04	H2944_124_0	3		1	07/09/2015	2016.01	07/09/2015 03:39:38 PM Eastern Daylight Time	08/01/2015 07:14:40 PM Eastern Daylight Time	07/29/2015 10:52:26 PM Eastern Daylight Time			08/04/2015 02:14:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-124 (PFFS)	04	09	3	1			H2944	124	0	2016	Select Counties in Indiana		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	127	0	1	09	04	H2944_127_0	3		1	07/09/2015	2016.01	07/09/2015 03:40:36 PM Eastern Daylight Time	07/31/2015 05:15:57 PM Eastern Daylight Time	07/29/2015 10:53:02 PM Eastern Daylight Time			08/04/2015 01:46:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-127 (PFFS)	04	09	3	1			H2944	127	0	2016	Select Counties in Kentucky		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	197	0	1	09	04	H2944_197_0	2		1	07/08/2015	2016.01	07/08/2015 03:16:37 PM Eastern Daylight Time	05/25/2015 11:16:18 AM Eastern Daylight Time				07/10/2015 02:27:46 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-197 (PFFS)	04	09	3	1			H2944	197	0	2016	Select Counties in KS, MO and OK		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2949	012	0	1	01	01	H2949_012_0	3		1	07/08/2015	2016.01	07/08/2015 12:43:06 PM Eastern Daylight Time	07/31/2015 04:06:05 PM Eastern Daylight Time	07/29/2015 10:53:36 PM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2949-012 (HMO)	01	01		1			H2949	012	0	2016	Clark (partial) and Nye (partial) counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2949	013	0	1	01	01	H2949_013_0	5		1	08/20/2015	2016.01	08/20/2015 03:38:33 PM Eastern Daylight Time	08/20/2015 11:18:06 AM Eastern Daylight Time	08/19/2015 04:15:56 PM Eastern Daylight Time			08/20/2015 04:55:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H2949	013	0	2016	Clark (partial) and Nye (partial) counties		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2949	014	0	1	01	01	H2949_014_0	5		1	08/20/2015	2016.01	08/20/2015 03:42:50 PM Eastern Daylight Time	08/20/2015 11:18:37 AM Eastern Daylight Time	08/19/2015 04:15:56 PM Eastern Daylight Time			08/20/2015 04:55:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CLD H2949-014 (HMO SNP)	01	01		1			H2949	014	0	2016	Clark (partial) and Nye (partial) counties		2		2			1	4		1		00000000000100000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2949	018	0	1	01	01	H2949_018_0	4		1	07/14/2015	2016.01	07/14/2015 09:59:51 AM Eastern Daylight Time		07/29/2015 10:55:22 PM Eastern Daylight Time		08/04/2015 12:10:40 PM Eastern Daylight Time	08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Kidney Care (HMO SNP)	01	01		1			H2949	018	0	2016	Clark (partial) and Nye (partial) counties		2		2			1	4		1		00000000100000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2949	805	0	1	01	01	H2949_805_0	1		1	05/11/2015	2016.01	05/11/2015 02:18:27 PM Eastern Daylight Time	05/29/2015 08:10:39 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2949	805	0	2016	Select counties in Nevada		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2949	807	0	1	01	01	H2949_807_0	1		1	05/11/2015	2016.01	05/11/2015 02:19:31 PM Eastern Daylight Time	05/29/2015 08:17:25 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2949	807	0	2016	Select counties in Nevada		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H2960	004	0	1	01	01	H2960_004_0	10		1	08/04/2015	2016.01	08/04/2015 06:48:01 PM Pacific Daylight Time	08/05/2015 02:09:59 PM Pacific Daylight Time	08/05/2015 02:10:00 PM Pacific Daylight Time			08/05/2015 02:24:30 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Enhanced Plan (HMO)	01	01		1			H2960	004	0	2016	Washoe County, NV		2	5800	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2960	009	0	1	01	01	H2960_009_0	5		1	07/23/2015	2016.01	07/23/2015 02:49:45 PM Pacific Daylight Time	06/01/2015 05:03:06 PM Pacific Daylight Time				07/23/2015 03:23:46 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Basic Plan (HMO)	01	01		1			H2960	009	0	2016	Washoe County, NV		2	489	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2960	012	0	1	01	01	H2960_012_0	8		1	08/04/2015	2016.01	08/04/2015 06:47:35 PM Pacific Daylight Time	08/05/2015 02:10:00 PM Pacific Daylight Time	08/05/2015 02:10:01 PM Pacific Daylight Time			08/05/2015 02:25:13 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Plan (HMO)	01	01		1			H2960	012	0	2016	Washoe County, NV		2	5466	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2960	018	0	1	01	01	H2960_018_0	8		1	08/04/2015	2016.01	08/04/2015 06:48:12 PM Pacific Daylight Time	08/05/2015 02:10:02 PM Pacific Daylight Time	08/05/2015 02:10:02 PM Pacific Daylight Time			08/05/2015 02:25:59 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN, INC.	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Select (HMO)	01	01		1			H2960	018	0	2016	Washoe County, NV		2	1495	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2960	803	0	1	01	01	H2960_803_0	2		1	05/16/2015	2016.01	05/16/2015 12:02:26 PM Pacific Daylight Time	06/01/2015 05:03:09 PM Pacific Daylight Time				06/01/2015 05:38:40 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	2016	State of Nevada		1	150	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1b;2;3-1;3-2;3-3;5;6;7e;7g;7h;8b1;8b2;9a;9b;11a;11b;12;	1	1b;2;5;6;7e;7g;7h;8b1;8b2;9a;9b;12;	1					1	2			
H2962	001	0	1	01	01	H2962_001_0	6		1	07/14/2015	2016.01	07/14/2015 08:34:30 PM Eastern Daylight Time	08/05/2015 09:50:55 AM Eastern Daylight Time	08/05/2015 10:01:28 AM Eastern Daylight Time			08/05/2015 03:40:18 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Premier (HMO)	01	01		1			H2962	001	0	2016	Hernando County		2	3277	2			2							www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)835-7163		(855)872-0006		(352)835-7151		(855)858-7526		(352)835-7163		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	002	0	1	01	01	H2962_002_0	7		1	07/14/2015	2016.01	07/14/2015 08:35:04 PM Eastern Daylight Time	08/05/2015 09:48:18 AM Eastern Daylight Time	08/05/2015 10:02:14 AM Eastern Daylight Time			08/05/2015 03:40:18 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Premier Plus (HMO)	01	01		1			H2962	002	0	2016	Hernando County		2	673	2			2							www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)835-7163		(855)872-0006		(352)835-7151		(855)858-7526		(352)835-7163		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	003	0	1	01	01	H2962_003_0	7		1	07/14/2015	2016.01	07/14/2015 08:35:29 PM Eastern Daylight Time	08/05/2015 09:52:53 AM Eastern Daylight Time	08/05/2015 10:42:40 AM Eastern Daylight Time			08/05/2015 03:40:18 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Elite (HMO)	01	01		1			H2962	003	0	2016	Pasco and Citrus Counties		2	3005	2			2							www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)835-7163		(855)872-0006		(352)835-7151		(855)858-7526		(352)835-7163		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	004	0	1	01	01	H2962_004_0	7		1	07/14/2015	2016.01	07/14/2015 08:35:54 PM Eastern Daylight Time	08/05/2015 10:00:14 AM Eastern Daylight Time	08/05/2015 10:37:54 AM Eastern Daylight Time			08/05/2015 03:40:18 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Elite Plus (HMO)	01	01		1			H2962	004	0	2016	Pasco and Citrus Counties		2	295	2			2							www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)835-7163		(855)872-0006		(352)835-7151		(855)858-7526		(352)835-7163		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2968	001	0	1	04	01	H2968_001_0	7		1	07/17/2015	2016.01	07/17/2015 02:58:32 PM Central Daylight Time	07/30/2015 09:15:16 AM Central Daylight Time	07/30/2015 09:22:58 AM Central Daylight Time			08/04/2015 02:59:06 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Insurance Company	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (PPO)	01	04		1			H2968	001	0	2016	Texas Counties - Harris, Montgomery, Fort Bend		2		2			2							healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org	healthplan.memorialhermann.org	(844)550-6896		(844)550-6896		(888)897-1337		(888)897-1337		(844)782-7672		(844)782-7672		(888)897-1337		(888)897-1337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2968	801	0	1	04	01	H2968_801_0	4		1	07/14/2015	2016.01	07/14/2015 01:18:32 PM Central Daylight Time	07/15/2015 10:46:04 AM Central Daylight Time				08/05/2015 09:56:55 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Insurance Company	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (PPO)	01	04		1			H2968	801	0	2016	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org	healthplan.memorialhermann.org	(844)550-6896		(844)550-6896		(888)897-1337		(888)897-1337		(844)782-7672		(844)782-7672		(888)897-1337		(888)897-1337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2968	802	0	1	04	01	H2968_802_0	4		1	07/13/2015	2016.01	07/13/2015 12:37:16 PM Central Daylight Time	07/15/2015 11:20:55 AM Central Daylight Time				08/05/2015 09:56:55 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Insurance Company	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (PPO)	01	04		1			H2968	802	0	2016	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org	healthplan.memorialhermann.org	(844)550-6896		(844)550-6896		(888)897-1337		(888)897-1337		(844)782-7672		(844)782-7672		(888)897-1337		(888)897-1337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2968	803	0	1	04	01	H2968_803_0	4		1	07/14/2015	2016.01	07/14/2015 01:21:15 PM Central Daylight Time	07/15/2015 10:47:08 AM Central Daylight Time				08/05/2015 09:56:55 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Insurance Company	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (PPO)	01	04		1			H2968	803	0	2016	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org	healthplan.memorialhermann.org	(844)550-6896		(844)550-6896		(888)897-1337		(888)897-1337										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2986	001	0	1	01	01	H2986_001_0	5		1	08/04/2015	2016.01	08/04/2015 09:16:51 AM Pacific Daylight Time	07/31/2015 01:16:10 PM Pacific Daylight Time	07/31/2015 11:33:41 AM Pacific Daylight Time			08/04/2015 09:21:57 AM Pacific Daylight Time	UNIVERSITY HEALTHCARE ADVANTAGE	University Health Care Advantage	www.stanfordhealthcareadvantage.org	Stanford Health Care Advantage - Platinum (HMO)	01	01		1			H2986	001	0	2016	Santa Clara County		2	2000	2			2							www.stanfordhealthcareadvantage.org	www.stanfordhealthcareadvantage.org	www.stanfordhealthcareadvantage.org	(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	002	0	1	01	01	H2986_002_0	5		1	08/04/2015	2016.01	08/04/2015 09:19:35 AM Pacific Daylight Time	07/31/2015 01:17:09 PM Pacific Daylight Time	07/31/2015 11:41:12 AM Pacific Daylight Time			08/04/2015 09:21:57 AM Pacific Daylight Time	UNIVERSITY HEALTHCARE ADVANTAGE	University Health Care Advantage	www.stanfordhealthcareadvantage.org	Stanford Health Care Advantage - Gold (HMO)	01	01		1			H2986	002	0	2016	Santa Clara County		2	2000	2			2							www.stanfordhealthcareadvantage.org	www.stanfordhealthcareadvantage.org	www.stanfordhealthcareadvantage.org	(855)996-8422		(855)996-8422		(844)205-8422		(844)205-8422		(800)243-2051		(800)243-2051		(844)205-8422		(844)205-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2992	001	0	1	20	08	H2992_001_0	1		1	05/20/2015	2016.01	05/20/2015 10:26:40 AM Eastern Daylight Time		05/18/2015 02:44:28 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifewashington.com	Senior LIFE Washington Dual Eligible (PACE)	08	20		1			H2992	001	0	2016	Senior LIFE Washington Greene County Dual Eligible		2	210	2			2								None	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	002	0	1	20	08	H2992_002_0	1		1	05/20/2015	2016.01	05/20/2015 10:26:55 AM Eastern Daylight Time		05/18/2015 02:44:28 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifewashington.com	Senior LIFE Washington Medicare Only (PACE)	08	20		1			H2992	002	0	2016	Senior LIFE Washington Greene County Medicare Only		2	1	2			2								None	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	003	0	1	20	08	H2992_003_0	1		1	05/20/2015	2016.01	05/20/2015 10:27:30 AM Eastern Daylight Time		05/18/2015 02:44:28 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifeuniontown.com	Senior LIFE Uniontown Dual Eligible (PACE)	08	20		1			H2992	003	0	2016	Senior LIFE Uniontown Fayette County Dual Eligible		2	216	2			2								None	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	004	0	1	20	08	H2992_004_0	1		1	05/20/2015	2016.01	05/20/2015 10:27:42 AM Eastern Daylight Time		05/18/2015 02:44:28 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifeuniontown.com	Senior LIFE Uniontown Medicare Only (PACE)	08	20		1			H2992	004	0	2016	Senior LIFE Fayette County Medicare Only		2	1	2			2								None	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3018	001	0	1	48	05	H3018_001_0	5		1	08/25/2015	2016.01	08/25/2015 05:00:38 PM Eastern Daylight Time					08/25/2015 05:02:48 PM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for FIDA Care Complete	www.centersplan.com	Centers Plan for FIDA Care Complete (Medicare-Medicaid Plan)	05	48		1			H3018	001	0	2016	Ki, Qu, Brx, NY, Ri Counties		2		2			2							www.centersplan.com	www.centersplan.com	www.centersplan.com	(800)466-2745		(800)466-2745		(800)466-2745		(800)466-2745		(888)266-7460		(888)266-7460		(800)466-2745		(800)466-2745		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2				
H3054	001	0	1	01	01	H3054_001_0	5	1	1	08/05/2015	2016.01	08/05/2015 04:47:09 PM Eastern Daylight Time	08/05/2015 04:28:12 PM Eastern Daylight Time	08/05/2015 04:34:23 PM Eastern Daylight Time			08/05/2015 04:56:49 PM Eastern Daylight Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Genesis - Constellation Health (HMO SNP)	01	01		1			H3054	001	0	2016	Puerto Rico		2	16226	2		1	1	3		1	3		1	www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H3054	003	0	1	01	01	H3054_003_0	5	1	1	08/05/2015	2016.01	08/05/2015 02:50:16 PM Eastern Daylight Time	08/05/2015 04:29:51 PM Eastern Daylight Time	08/05/2015 04:35:16 PM Eastern Daylight Time			08/05/2015 04:56:49 PM Eastern Daylight Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Genesis Prime - Constellation Health (HMO SNP)	01	01		1			H3054	003	0	2016	Puerto Rico		2	3500	2		1	1	3		1	3		1	www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H3060	001	0	1	20	08	H3060_001_0	1		1	05/22/2015	2016.01	05/22/2015 03:40:14 PM Eastern Daylight Time		05/21/2015 09:58:00 AM Eastern Daylight Time			05/22/2015 03:47:51 PM Eastern Daylight Time	VIECARE BUTLER, LLC	LIFE Butler County	www.lutheranseniorlife.org	VIECARE BUTLER LLC DBA LIFE BUTLER COUNTY (PACE)	08	20		1			H3060	001	0	2016	LIFE Butler		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(724)287-5433		(724)742-2226		(724)287-5433		(724)742-2226										(724)287-5433		(724)742-2226		(724)287-5433		(724)742-2226																
H3060	002	0	1	20	08	H3060_002_0	1		1	05/22/2015	2016.01	05/22/2015 03:41:07 PM Eastern Daylight Time		05/21/2015 10:04:46 AM Eastern Daylight Time			05/22/2015 03:47:51 PM Eastern Daylight Time	VIECARE BUTLER, LLC	LIFE Butler County	www.lutheranseniorlife.org	VIECARE BUTLER LLC DBA LIFE BUTLER COUNTY (PACE)	08	20		1			H3060	002	0	2016	LIFE Butler		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(724)287-5433		(724)742-2226		(724)287-5433		(724)742-2226										(724)287-5433		(724)742-2226		(724)287-5433		(724)742-2226																
H3067	001	0	1	48	05	H3067_001_0	3		1	08/31/2015	2016.01	08/31/2015 10:09:05 AM Eastern Daylight Time					08/31/2015 10:20:53 AM Eastern Daylight Time	VIRGINIA PREMIER HEALTH PLAN, INC.	Virginia Premier CompleteCare	www.vapremier.com	Virginia Premier Health Plan, Inc. (Medicare-Medicaid Plan)	05	48		1			H3067	001	0	2016	Central, Tidewater, Northern, Western, Roanoke		2	5500	2			2							www.vapremier.com	www.vapremier.com	www.vapremier.com	(855)338-6467		(804)819-5151		(855)338-6467		(804)819-5151		(855)338-6467		(804)819-5151		(855)338-6467		(804)819-5151		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		2					2					2				
H3071	001	0	1	01	01	H3071_001_0	14	2	1	08/05/2015	2016.01	08/05/2015 07:07:50 AM Central Daylight Time	07/21/2015 01:26:21 PM Central Daylight Time	06/23/2015 10:10:18 AM Central Daylight Time			08/05/2015 11:36:04 AM Central Daylight Time	COMMUNITY CARE ALLIANCE OF ILLINOIS, NFP	Community Care Alliance of Illinois, NFP	https://www.ccaillinois.com/medicare	Community Care Alliance of Illinois, NFP (HMO SNP)	01	01		1			H3071	001	0	2016	Rockford Area, Chicago Area		2	2000	2			1	3		1	3		2	https://www.ccaillinois.com/medicare	https://www.ccaillinois.com/medicare	www.cvs.com	(855)275-2781		(855)275-2781		(855)275-2781		(855)275-2781		(888)232-8479		(888)232-8479		(888)232-8479		(888)232-8479		(888)461-2378		(888)461-2378		(888)461-2378		(888)461-2378		(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069		2					2					2	2			
H3071	002	0	1	01	01	H3071_002_0	12		1	07/14/2015	2016.01	07/14/2015 04:54:17 PM Central Daylight Time	08/05/2015 03:52:31 PM Central Daylight Time	08/05/2015 03:53:31 PM Central Daylight Time			08/06/2015 11:13:16 AM Central Daylight Time	COMMUNITY CARE ALLIANCE OF ILLINOIS, NFP	Community Care Alliance of Illinois, NFP	https://www.ccaillinois.com/medicare	Community Care Alliance of Illinois (HMO)	01	01		1			H3071	002	0	2016	Rockford Area, Chicago Area		2	750	2			2							https://www.ccaillinois.com/medicare	https://www.ccaillinois.com/medicare	www.cvs.com	(855)275-2781		(855)275-2781		(855)275-2781		(855)275-2781		(888)232-8479		(888)232-8479		(888)232-8479		(888)232-8479		(888)461-2378		(888)461-2378		(888)461-2378		(888)461-2378		(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069		2					2					2	2			
H3107	004	0	1	01	01	H3107_004_0	3		1	07/31/2015	2016.01	07/31/2015 10:41:45 AM Central Daylight Time	07/31/2015 12:31:21 PM Central Daylight Time	07/30/2015 09:47:52 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3107	004	0	2016	Northern and Central 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	2			
H3107	008	0	1	01	01	H3107_008_0	2		1	07/13/2015	2016.01	07/13/2015 08:34:33 AM Central Daylight Time	05/29/2015 03:57:15 PM Central Daylight Time				07/13/2015 01:27:27 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H3107	008	0	2016	Northern and Central 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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3107	012	0	1	01	01	H3107_012_0	3		1	07/31/2015	2016.01	07/31/2015 10:44:16 AM Central Daylight Time	07/31/2015 12:31:44 PM Central Daylight Time	07/30/2015 09:48:31 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3107	012	0	2016	Essex and Ocean County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3107	013	0	1	01	01	H3107_013_0	3		1	07/31/2015	2016.01	07/31/2015 10:46:27 AM Central Daylight Time	07/31/2015 12:32:08 PM Central Daylight Time	07/30/2015 09:48:49 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Focus (HMO)	01	01		1			H3107	013	0	2016	Northern and Central 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	2			
H3107	014	0	1	01	01	H3107_014_0	3		1	07/31/2015	2016.01	07/31/2015 10:48:23 AM Central Daylight Time	07/31/2015 12:32:32 PM Central Daylight Time	07/30/2015 09:49:06 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H3107	014	0	2016	Northern and Central 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	2			
H3107	015	0	1	01	01	H3107_015_0	3		1	07/31/2015	2016.01	07/31/2015 10:50:14 AM Central Daylight Time	07/31/2015 12:32:55 PM Central Daylight Time	07/30/2015 09:49:23 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 4 (HMO)	01	01		1			H3107	015	0	2016	Select counties in 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	2			
H3107	801	0	1	01	01	H3107_801_0	1		1	04/13/2015	2016.01	04/13/2015 01:37:15 PM Central Daylight Time	05/29/2015 03:59:52 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3107	801	0	2016	State of New Jersey Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H3107	803	0	1	01	01	H3107_803_0	1		1	04/13/2015	2016.01	04/13/2015 01:38:08 PM Central Daylight Time	05/29/2015 04:00:24 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3107	803	0	2016	State of New Jersey Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H3107	804	0	1	01	01	H3107_804_0	1		1	04/13/2015	2016.01	04/13/2015 01:38:58 PM Central Daylight Time	05/29/2015 04:00:57 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3107	804	0	2016	Morris NJ		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H3113	001	0	1	01	01	H3113_001_0	3		1	07/31/2015	2016.01	07/31/2015 09:44:04 AM Central Daylight Time	07/31/2015 01:15:23 PM Central Daylight Time	07/30/2015 09:49:43 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3113	001	0	2016	Northern and Central New Jersey		2		2			1	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	2	1	05/26/2015	2016.01	05/26/2015 08:33:06 AM Central Daylight Time	07/31/2015 01:15:47 PM Central Daylight Time	07/30/2015 09:50:01 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO SNP)	01	01		1			H3113	005	0	2016	Select counties in New Jersey		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	007	0	1	01	01	H3113_007_0	2		1	07/31/2015	2016.01	07/31/2015 09:44:15 AM Central Daylight Time	07/31/2015 01:16:13 PM Central Daylight Time	07/30/2015 09:50:20 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3113	007	0	2016	St. Louis County and St. Louis City		2		2			1	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	008	0	1	01	01	H3113_008_0	3		1	05/29/2015	2016.01	05/29/2015 10:48:05 AM Central Daylight Time	07/31/2015 01:16:38 PM Central Daylight Time	07/30/2015 09:50:36 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO SNP)	01	01		1			H3113	008	0	2016	Clackamas, Lane, Multnomah,and Washington counties		2		2			1	1	2	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	009	0	1	01	01	H3113_009_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:35:28 AM Central Daylight Time	07/31/2015 01:17:02 PM Central Daylight Time	07/30/2015 09:50:53 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H3113	009	0	2016	Select counties in Pennsylvania		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			
H3129	001	0	1	48	05	H3129_001_0	4		1	08/18/2015	2016.01	08/18/2015 04:29:03 PM Eastern Daylight Time					08/18/2015 04:50:34 PM Eastern Daylight Time	NORTH SHORE-LIJ HEALTH PLAN, INC.	North Shore-LIJ Health Plan, Inc.	www.nslijhealthplans.com/fidalivewell	North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan)	05	48		1			H3129	001	0	2016	Ki, Qu, NY, Ri, Suf, Na		2	1100	2			2							www.nslijhealthplans.com/fidalivewell/participants	www.nslijhealthplans.com/fidalivewell	www.nslijhealthplans.com/fidalivewell	(855)776-7545		(855)776-7545		(855)776-7545		(855)776-7545		(855)776-7545		(855)776-7545		(855)776-7545		(855)776-7545		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H3132	001	0	1	01	01	H3132_001_0	10		1	08/04/2015	2016.01	08/04/2015 02:36:29 PM Pacific Daylight Time	08/05/2015 04:33:10 PM Pacific Daylight Time	08/05/2015 04:33:10 PM Pacific Daylight Time			08/05/2015 04:45:18 PM Pacific Daylight Time	AHF MCO OF FLORIDA, INC.	AHF	www.php-fl.org	PHP (HMO SNP)	01	01		1			H3132	001	0	2016	Broward, Miami-Dade and Duval Counties, Florida		2	1429	2			1	4		1		00000000001000000000		www.php-fl.org/consider-php/provider-pharmacy-networks	www.php-fl.org/for-members/drug-benefit/formulary	www.php-fl.org/consider-php/provider-pharmacy-networks	(888)456-4715		(888)456-4715		(888)456-4715		(888)456-4715		(866)763-9096		(866)763-9096		(888)456-4715		(888)456-4715		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	022	0	1	01	01	H3152_022_0	6		1	08/02/2015	2016.01	08/02/2015 06:40:54 PM Eastern Daylight Time	08/03/2015 04:35:22 PM Eastern Daylight Time	07/29/2015 05:10:52 PM Eastern Daylight Time			08/03/2015 05:09:19 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3152	022	0	2016	Southern NJ		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	045	0	1	01	01	H3152_045_0	4		1	07/16/2015	2016.01	07/16/2015 05:44:01 PM Eastern Daylight Time	07/14/2015 10:40:36 AM Eastern Daylight Time				07/16/2015 05:51:25 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basic Plan (HMO)	01	01		1			H3152	045	0	2016	Northern NJ		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3152	046	0	1	01	01	H3152_046_0	4		1	08/02/2015	2016.01	08/02/2015 06:43:01 PM Eastern Daylight Time	08/01/2015 06:24:34 AM Eastern Daylight Time	07/29/2015 05:11:10 PM Eastern Daylight Time			08/02/2015 07:08:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3152	046	0	2016	Ocean County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	048	0	1	01	01	H3152_048_0	6		1	08/02/2015	2016.01	08/02/2015 06:43:30 PM Eastern Daylight Time	08/01/2015 06:35:25 AM Eastern Daylight Time	07/29/2015 05:11:29 PM Eastern Daylight Time			08/02/2015 07:08:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H3152	048	0	2016	Northern New Jersey		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	077	0	1	01	01	H3152_077_0	5		1	08/02/2015	2016.01	08/02/2015 06:43:47 PM Eastern Daylight Time	07/31/2015 03:24:51 PM Eastern Daylight Time	07/29/2015 05:11:48 PM Eastern Daylight Time			08/02/2015 07:08:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3152	077	0	2016	Camden, Gloucester and Mercer counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	080	0	1	01	01	H3152_080_0	4		1	08/02/2015	2016.01	08/02/2015 06:44:52 PM Eastern Daylight Time	08/01/2015 09:16:29 AM Eastern Daylight Time	07/29/2015 05:12:07 PM Eastern Daylight Time			08/02/2015 07:08:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare NNJ Prime Plan (HMO)	01	01		1			H3152	080	0	2016	Northern New Jersey		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	082	0	1	01	01	H3152_082_0	5		1	08/03/2015	2016.01	08/03/2015 05:36:21 PM Eastern Daylight Time	08/03/2015 06:09:22 PM Eastern Daylight Time	07/29/2015 05:12:26 PM Eastern Daylight Time			08/04/2015 11:32:33 AM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H3152	082	0	2016	Ocean and Monmounth County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	801	0	1	01	01	H3152_801_0	3		1	06/01/2015	2016.01	06/01/2015 10:50:09 AM Eastern Daylight Time	07/16/2015 05:25:11 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3152	801	0	2016	New Jersey		1	14788	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1	2			
H3152	804	0	1	01	01	H3152_804_0	2		1	05/29/2015	2016.01	05/29/2015 12:12:12 PM Eastern Daylight Time	07/16/2015 05:25:12 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3152	804	0	2016	New Jersey		1	2693	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H3154	004	0	1	01	01	H3154_004_0	9		1	07/06/2015	2016.01	07/06/2015 08:57:17 AM Eastern Daylight Time	08/03/2015 01:17:29 PM Eastern Daylight Time	08/03/2015 01:16:47 PM Eastern Daylight Time			08/03/2015 01:48:30 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/medicare	Horizon Medicare Blue Value w/ Rx (HMO)	01	01		1			H3154	004	0	2016	Counties:  CPM, ESX, HUD, OCN, SLM, UNN, WRN		2	6067	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2	2			
H3154	013	0	1	01	01	H3154_013_0	6		1	07/06/2015	2016.01	07/06/2015 08:59:08 AM Eastern Daylight Time	07/01/2015 01:14:04 PM Eastern Daylight Time				07/06/2015 02:43:35 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/medicare	Horizon Medicare Blue Value (HMO)	01	01		1			H3154	013	0	2016	Counties:  CPM, ESX, HUD, OCN, SLM, UNN, WRN		2	787	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142										(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899										2					2					2	2			
H3154	022	0	1	01	01	H3154_022_0	9		1	07/06/2015	2016.01	07/06/2015 09:00:54 AM Eastern Daylight Time	08/03/2015 01:19:17 PM Eastern Daylight Time	08/03/2015 01:18:35 PM Eastern Daylight Time			08/03/2015 01:48:30 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/medicare	Horizon Medicare Blue Choice w/Rx (HMO)	01	01		1			H3154	022	0	2016	14 Counties Throughout New Jersey		2	6282	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2	2			
H3154	024	0	1	01	01	H3154_024_0	5		1	07/30/2015	2016.01	07/30/2015 12:07:03 PM Eastern Daylight Time	08/03/2015 01:21:34 PM Eastern Daylight Time	08/03/2015 01:20:22 PM Eastern Daylight Time			08/03/2015 01:48:30 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/medicare	Horizon Medicare Blue Patient-Centered w/Rx (HMO)	01	01		1			H3154	024	0	2016	Essex, Hudson, Ocean, Salem, and Warren Counties		2	4350	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2	1	01	7a;	
H3154	026	0	1	01	01	H3154_026_0	6		1	07/06/2015	2016.01	07/06/2015 09:09:27 AM Eastern Daylight Time	08/03/2015 01:23:32 PM Eastern Daylight Time	08/03/2015 01:22:21 PM Eastern Daylight Time			08/03/2015 01:48:30 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/medicare	Horizon Medicare Blue Patient-Centered w/Rx (HMO)	01	01		1			H3154	026	0	2016	Middlesex, Morris, Sussex, and Union Counties		2	2091	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2	1	01	7a;	
H3154	027	0	1	01	01	H3154_027_0	6		1	07/06/2015	2016.01	07/06/2015 09:10:55 AM Eastern Daylight Time	08/03/2015 01:25:50 PM Eastern Daylight Time	08/03/2015 01:24:40 PM Eastern Daylight Time			08/03/2015 01:48:30 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/medicare	Horizon Medicare Blue Patient-Centered w/Rx (HMO)	01	01		1			H3154	027	0	2016	Counties: BRG, CPM, MRR, MMT, PSC, SMS		2	2306	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2	1	01	7a;	
H3154	028	0	1	01	01	H3154_028_0	6		1	07/06/2015	2016.01	07/06/2015 09:12:14 AM Eastern Daylight Time	08/03/2015 01:27:43 PM Eastern Daylight Time	08/03/2015 01:26:48 PM Eastern Daylight Time			08/03/2015 01:48:30 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/medicare	Horizon Medicare Blue Patient-Centered w/Rx (HMO)	01	01		1			H3154	028	0	2016	Counties: ATL, CMD, CMN, GLC, HNT		2	1886	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2	1	01	7a;	
H3154	801	0	1	02	01	H3154_801_0	4		1	07/06/2015	2016.01	07/06/2015 09:31:30 AM Eastern Daylight Time	05/31/2015 10:36:51 AM Eastern Daylight Time				07/06/2015 02:43:35 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Group (HMO-POS)	01	02		1			H3154	801	0	2016	New Jersey		1	1547	2			2							http://directory.horizonblue.com/	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	https://medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142										(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899										2					2					2	2			
H3154	802	0	1	02	01	H3154_802_0	6		1	07/06/2015	2016.01	07/06/2015 09:33:23 AM Eastern Daylight Time	06/01/2015 09:58:27 AM Eastern Daylight Time				07/06/2015 02:43:35 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Grp w/ Rx (HMO-POS)	01	02		1			H3154	802	0	2016	New Jersey		1	1330	2			2							http://directory.horizonblue.com/	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en/find-medicine.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en.html	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2	2			
H3154	805	0	1	02	01	H3154_805_0	4		1	07/06/2015	2016.01	07/06/2015 09:35:11 AM Eastern Daylight Time	05/29/2015 11:07:14 AM Eastern Daylight Time				07/06/2015 02:43:35 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Grp w/ Rx (HMO-POS)	01	02		1			H3154	805	0	2016	New Jersey		1	200	2			2							http://directory.horizonblue.com/	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en/find-medicine.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en.html	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2	2			
H3156	029	0	1	01	01	H3156_029_0	2		1	05/27/2015	2016.01	05/27/2015 10:09:08 AM Eastern Daylight Time	05/30/2015 05:02:44 PM Eastern Daylight Time				05/30/2015 05:06:46 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Medical Only (HMO)	01	01		1			H3156	029	0	2016	Counties: BR CM CU EX GL HD HN MX MR OC SL SM UN		2	795	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3156	030	0	1	01	01	H3156_030_0	4		1	05/27/2015	2016.01	05/27/2015 10:09:25 AM Eastern Daylight Time	08/04/2015 11:10:21 AM Eastern Daylight Time	08/04/2015 11:10:21 AM Eastern Daylight Time			08/04/2015 04:37:08 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Rx (HMO)	01	01		1			H3156	030	0	2016	Counties: BR CM CU EX GL HD HN MX MR OC SL SM UN		2	17504	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3156	033	0	1	01	01	H3156_033_0	2		1	05/27/2015	2016.01	05/27/2015 10:09:40 AM Eastern Daylight Time	05/30/2015 05:02:48 PM Eastern Daylight Time				05/30/2015 05:15:07 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Medical Only (HMO)	01	01		1			H3156	033	0	2016	Counties: BG, CP, MN, MS, PS, SX, WR		2	17	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3156	034	0	1	01	01	H3156_034_0	5		1	05/27/2015	2016.01	05/27/2015 10:10:14 AM Eastern Daylight Time	08/04/2015 11:10:21 AM Eastern Daylight Time	08/04/2015 11:10:21 AM Eastern Daylight Time			08/04/2015 04:43:39 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Rx (HMO)	01	01		1			H3156	034	0	2016	Counties: BG, CP, MN, MS, PS, SX, WR		2	563	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3156	035	0	1	01	01	H3156_035_0	2		1	05/27/2015	2016.01	05/27/2015 10:10:28 AM Eastern Daylight Time	05/30/2015 05:02:42 PM Eastern Daylight Time				05/30/2015 05:23:19 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Medical Only (HMO)	01	01		1			H3156	035	0	2016	County: Atlantic		2	23	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3156	036	0	1	01	01	H3156_036_0	3		1	05/30/2015	2016.01	05/30/2015 04:56:59 PM Eastern Daylight Time	08/04/2015 11:10:21 AM Eastern Daylight Time	08/04/2015 11:10:22 AM Eastern Daylight Time			08/04/2015 04:51:27 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Rx (HMO)	01	01		1			H3156	036	0	2016	County: Atlantic		2	216	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3156	801	0	1	01	01	H3156_801_0	1		1	05/27/2015	2016.01	05/27/2015 10:11:03 AM Eastern Daylight Time	05/30/2015 04:04:42 PM Eastern Daylight Time				05/30/2015 04:36:29 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 NJ Group Medical Only (HMO)	01	01		1			H3156	801	0	2016	State of New Jersey		1	281	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;	1	7b;7c;7d;7f;7g;7i;8b1;8b2;8b3;16b;18a;	1					1	2			
H3156	803	0	1	01	01	H3156_803_0	1		1	05/27/2015	2016.01	05/27/2015 10:11:32 AM Eastern Daylight Time	05/30/2015 04:04:42 PM Eastern Daylight Time				05/30/2015 04:38:41 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 NJ Group Rx (HMO)	01	01		1			H3156	803	0	2016	State of New Jersey		1	175	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;	1	7b;7c;7d;7f;7g;7i;8b1;8b2;8b3;16b;18a;	1					1	2			
H3204	001	0	1	01	01	H3204_001_0	6		1	08/04/2015	2016.01	08/04/2015 12:29:33 PM Mountain Daylight Time	08/03/2015 12:00:00 AM Mountain Daylight Time	08/03/2015 12:00:00 AM Mountain Daylight Time			08/04/2015 12:37:34 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 2 with Rx (HMO)	01	01		1			H3204	001	0	2016	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	21541	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2					2	2			
H3204	007	0	1	01	01	H3204_007_0	6		1	08/04/2015	2016.01	08/04/2015 12:29:39 PM Mountain Daylight Time	08/03/2015 12:00:00 AM Mountain Daylight Time	08/03/2015 12:00:00 AM Mountain Daylight Time			08/04/2015 12:37:34 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 3 with Rx (HMO)	01	01		1			H3204	007	0	2016	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	5056	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2					2	2			
H3204	008	0	1	01	01	H3204_008_0	4		1	07/08/2015	2016.01	07/08/2015 08:44:04 AM Mountain Daylight Time	05/29/2015 01:52:11 PM Mountain Daylight Time				07/15/2015 08:01:46 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 1 (HMO)	01	01		1			H3204	008	0	2016	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	1847	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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	801	0	1	01	01	H3204_801_0	4		1	05/28/2015	2016.01	05/28/2015 08:32:13 AM Mountain Daylight Time	06/01/2015 07:50:39 AM Mountain Daylight Time				06/01/2015 08:16:27 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 with Rx (HMO)	01	01		1			H3204	801	0	2016	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	171	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		1					1	2			
H3204	802	0	1	01	01	H3204_802_0	3		1	05/28/2015	2016.01	05/28/2015 08:32:23 AM Mountain Daylight Time	06/01/2015 07:51:16 AM Mountain Daylight Time				06/01/2015 08:16:27 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 1 (HMO)	01	01		1			H3204	802	0	2016	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		1					1	2			
H3204	803	0	1	01	01	H3204_803_0	3		1	05/28/2015	2016.01	05/28/2015 08:32:31 AM Mountain Daylight Time	06/01/2015 07:51:53 AM Mountain Daylight Time				06/01/2015 08:16:27 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 w/ Rx NC (HMO)	01	01		1			H3204	803	0	2016	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		1					1	2			
H3204	808	0	1	02	01	H3204_808_0	3		1	05/28/2015	2016.01	05/28/2015 08:32:46 AM Mountain Daylight Time	05/29/2015 01:57:10 PM Mountain Daylight Time				06/01/2015 08:16:27 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 (HMO-POS)	01	02		1			H3204	808	0	2016	State of New Mexico		1	6108	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		1	2		2		1	2			
H3204	809	0	1	02	01	H3204_809_0	3		1	05/28/2015	2016.01	05/28/2015 08:32:54 AM Mountain Daylight Time	05/29/2015 01:58:21 PM Mountain Daylight Time				06/01/2015 08:16:27 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 6 (HMO-POS)	01	02		1			H3204	809	0	2016	State of New Mexico		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		1	2		2		1	2			
H3204	810	0	1	02	01	H3204_810_0	3		1	05/28/2015	2016.01	05/28/2015 08:33:03 AM Mountain Daylight Time	05/29/2015 01:59:05 PM Mountain Daylight Time				06/01/2015 08:16:27 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 (HMO-POS)	01	02		1			H3204	810	0	2016	State of New Mexico		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		1	2		2		1	2			
H3206	001	0	1	04	01	H3206_001_0	7		1	08/04/2015	2016.01	08/04/2015 12:29:50 PM Mountain Daylight Time	08/03/2015 12:00:00 AM Mountain Daylight Time	08/03/2015 12:00:00 AM Mountain Daylight Time			08/04/2015 12:37:34 PM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 2 with Rx (PPO)	01	04		1			H3206	001	0	2016	State of New Mexico		2	3240	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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	002	0	1	04	01	H3206_002_0	8		1	09/18/2015	2016.01	09/18/2015 09:07:48 AM Mountain Daylight Time	08/03/2015 12:00:00 AM Mountain Daylight Time	08/03/2015 12:00:00 AM Mountain Daylight Time			09/18/2015 09:15:11 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 3 with Rx (PPO)	01	04		1			H3206	002	0	2016	State of New Mexico		2	1404	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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	5		1	07/17/2015	2016.01	07/17/2015 08:46:41 AM Mountain Daylight Time	05/29/2015 02:01:05 PM Mountain Daylight Time				07/17/2015 09:00:51 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 1 (PPO)	01	04		1			H3206	003	0	2016	State of New Mexico		2	339	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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	05/28/2015	2016.01	05/28/2015 08:33:48 AM Mountain Daylight Time	05/29/2015 02:01:26 PM Mountain Daylight Time				06/01/2015 08:16:27 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Pres MediCare PPO Emp Group Plan 2 with Rx (PPO)	01	04		1			H3206	801	0	2016	State of New Mexico		1	3888	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		1						2			
H3206	802	0	1	04	01	H3206_802_0	3		1	05/28/2015	2016.01	05/28/2015 08:33:57 AM Mountain Daylight Time	05/29/2015 02:01:49 PM Mountain Daylight Time				06/01/2015 08:16:27 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Pres Medicare PPO Employer Group Plan 1 (PPO)	01	04		1			H3206	802	0	2016	State of New Mexico		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		1						2			
H3206	803	0	1	04	01	H3206_803_0	3		1	05/28/2015	2016.01	05/28/2015 08:34:05 AM Mountain Daylight Time	05/29/2015 02:02:13 PM Mountain Daylight Time				06/01/2015 08:16:27 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Pres MediCare PPO Empl Group Plan 2 +Rx NC (PPO)	01	04		1			H3206	803	0	2016	State of New Mexico		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(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;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		1						2			
H3233	001	0	1	01	01	H3233_001_0	9		1	07/21/2015	2016.01	07/21/2015 11:32:04 PM Eastern Daylight Time	08/05/2015 05:40:00 PM Eastern Daylight Time	08/05/2015 05:40:01 PM Eastern Daylight Time			08/05/2015 05:42:53 PM Eastern Daylight Time	PREMIER HEALTH INSURING CORPORATION	Premier Health Plan	premierhealthplan.org/medicare	Premier Health Advantage (HMO)	01	01		1			H3233	001	0	2016	Dayton Metro		2		2			2							premierhealthplan.org/medicare	premierhealthplan.org/medicare	premierhealthplan.org/medicare	(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157		(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2	2			
H3233	002	0	1	01	01	H3233_002_0	9	2	1	08/04/2015	2016.01	08/04/2015 04:08:28 PM Eastern Daylight Time	08/05/2015 05:40:01 PM Eastern Daylight Time	08/05/2015 05:39:59 PM Eastern Daylight Time			08/05/2015 05:42:53 PM Eastern Daylight Time	PREMIER HEALTH INSURING CORPORATION	Premier Health Plan	premierhealthplan.org/medicare	Premier Health Advantage VIP (HMO SNP)	01	01		1			H3233	002	0	2016	Dayton Metro		2		2			1	3		1	3		2	premierhealthplan.org/medicare	premierhealthplan.org/medicare	premierhealthplan.org/medicare	(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157		(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2	2			
H3233	801	0	1	01	01	H3233_801_0	2		1	05/27/2015	2016.01	05/27/2015 12:51:46 PM Eastern Daylight Time	05/31/2015 01:28:04 PM Eastern Daylight Time				06/01/2015 09:32:29 PM Eastern Daylight Time	PREMIER HEALTH INSURING CORPORATION	Premier Health Plan	premierhealthplan.org/medicare	Premier Health Advantage EGWP (HMO)	01	01		1			H3233	801	0	2016	Dayton Metro		1		2			2							premierhealthplan.org/medicare	premierhealthplan.org/medicare	premierhealthplan.org/medicare	(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157		(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;15;	2		1					1	2			
H3233	802	0	1	01	01	H3233_802_0	2		1	05/27/2015	2016.01	05/27/2015 12:36:26 PM Eastern Daylight Time	05/31/2015 01:30:12 PM Eastern Daylight Time				06/01/2015 09:32:29 PM Eastern Daylight Time	PREMIER HEALTH INSURING CORPORATION	Premier Health Plan	premierhealthplan.org/medicare	Premier Health Advantage EGWP (HMO)	01	01		1			H3233	802	0	2016	Dayton Metro		1		2			2							premierhealthplan.org/medicare	premierhealthplan.org/medicare	premierhealthplan.org/medicare	(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157		(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;15;	2		1					1	2			
H3233	803	0	1	01	01	H3233_803_0	2		1	05/27/2015	2016.01	05/27/2015 12:36:07 PM Eastern Daylight Time	05/31/2015 01:32:54 PM Eastern Daylight Time				06/01/2015 09:32:29 PM Eastern Daylight Time	PREMIER HEALTH INSURING CORPORATION	Premier Health Plan	premierhealthplan.org/medicare	Premier Health Advantage EGWP (HMO)	01	01		1			H3233	803	0	2016	Dayton Metro		1		2			2							premierhealthplan.org/medicare	premierhealthplan.org/medicare	premierhealthplan.org/medicare	(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157										(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;15;	2		1					1	2			
H3233	804	0	1	01	01	H3233_804_0	2		1	05/27/2015	2016.01	05/27/2015 12:35:53 PM Eastern Daylight Time	05/31/2015 01:35:12 PM Eastern Daylight Time				06/01/2015 09:32:29 PM Eastern Daylight Time	PREMIER HEALTH INSURING CORPORATION	Premier Health Plan	premierhealthplan.org/medicare	Premier Health Advantage EGWP (HMO)	01	01		1			H3233	804	0	2016	Dayton Metro		1		2			2							premierhealthplan.org/medicare	premierhealthplan.org/medicare	premierhealthplan.org/medicare	(855)572-2161		(855)572-2161		(855)572-2157		(855)572-2157										(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;15;	2		1					1	2			
H3237	001	0	1	48	05	H3237_001_0	4		1	07/09/2015	2016.01	07/09/2015 06:10:21 PM Pacific Daylight Time					07/10/2015 03:43:51 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Health Net Cal MediConnect Medicare Medicaid Plan	www.healthnet.com/calmediconnect	Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H3237	001	0	2016	Los Angeles County		2		2			2							www.healthnet.com/calmediconnect	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(855)464-3571		(855)464-3571		(888)788-5395		(888)788-5395		(855)464-3571		(855)464-3571		(888)788-5395		(888)788-5395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H3237	002	0	1	48	05	H3237_002_0	4		1	07/09/2015	2016.01	07/09/2015 06:10:52 PM Pacific Daylight Time					07/10/2015 03:43:51 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Health Net Cal MediConnect Medicare Medicaid Plan	www.healthnet.com/calmediconnect	Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H3237	002	0	2016	San Diego County		2		2			2							www.healthnet.com/calmediconnect	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(855)464-3572		(855)464-3572		(888)788-5805		(888)788-5805		(855)464-3572		(855)464-3572		(888)788-5805		(888)788-5805		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H3240	013	0	1	01	01	H3240_013_0	10	2	1	07/06/2015	2016.01	07/06/2015 12:19:18 PM Pacific Daylight Time	08/04/2015 07:32:27 AM Pacific Daylight Time	07/30/2015 04:19:38 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H3240	013	0	2016	Eastern and Central New Jersey		2	8630	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H3240	016	0	1	01	01	H3240_016_0	10	2	1	07/06/2015	2016.01	07/06/2015 12:19:32 PM Pacific Daylight Time	08/04/2015 07:33:09 AM Pacific Daylight Time	07/30/2015 04:44:05 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H3240	016	0	2016	Select Counties in New Jersey		2	520	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H3251	002	0	1	01	01	H3251_002_0	9		1	07/16/2015	2016.01	07/16/2015 01:03:42 PM Central Daylight Time	08/03/2015 03:29:30 PM Central Daylight Time	08/03/2015 02:23:04 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Lovelace Medicare Plan provided by BCBSNM	www.mylovelacemedicarenm.com	Lovelace Medicare Plan $0 (HMO)	01	01		1			H3251	002	0	2016	Greater New Mexico Area		2		2			2							www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	021	0	1	02	01	H3251_021_0	9		1	07/15/2015	2016.01	07/15/2015 04:33:00 PM Central Daylight Time	08/03/2015 03:30:04 PM Central Daylight Time	08/03/2015 02:24:44 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Lovelace Medicare Plan provided by BCBSNM	www.mylovelacemedicarenm.com	Lovelace Medicare Plan Enhanced (HMO-POS)	01	02		1			H3251	021	0	2016	Greater New Mexico Area		2		2			2							www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	804	0	1	01	01	H3251_804_0	2		1	05/01/2015	2016.01	05/05/2015 04:36:18 PM Central Daylight Time	05/31/2015 02:14:29 PM Central Daylight Time				05/31/2015 03:55:14 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Lovelace Medicare Plan provided by BCBSNM	www.mylovelacemedicarenm.com	Lovelace Employer Group Medicare Plan (HMO)	01	01		1			H3251	804	0	2016	New Mexico Statewide		1	5663	2			2							www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H3259	001	0	1	01	01	H3259_001_0	6	2	1	08/03/2015	2016.01	08/03/2015 12:17:50 PM Eastern Daylight Time	08/05/2015 08:26:46 AM Eastern Daylight Time	08/05/2015 08:26:46 AM Eastern Daylight Time			08/05/2015 11:17:09 AM Eastern Daylight Time	VOLUNTEER STATE HEALTH PLAN	BlueCare Plus Tennessee	bluecareplus.bcbst.com	BlueCare Plus (HMO SNP)	01	01		1			H3259	001	0	2016	Tennessee		2	10000	2			1	3		1	4			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			
H3291	001	0	1	01	01	H3291_001_0	6		1	08/05/2015	2016.01	08/05/2015 11:39:21 AM Eastern Daylight Time	08/03/2015 07:14:44 PM Eastern Daylight Time	08/03/2015 05:07:20 PM Eastern Daylight Time			08/05/2015 02:22:21 PM Eastern Daylight Time	PRUITTHEALTH PREMIER, INC.	PruittHealth Premier (HMO SNP)	www.pruitthealthpremier.com	PruittHealth Premier (HMO SNP)	01	01		1			H3291	001	0	2016	GA Counties: BIB, CLK, HAB, HAL & MRO		2		2			1	1	1	1				www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(800)255-0056		(771)-		(800)255-0056		(771)-		(800)255-0056		(771)-		(800)255-0056		(771)-		2					1					2	2			
H3305	007	0	1	02	01	H3305_007_0	7		1	07/24/2015	2016.01	07/24/2015 04:34:28 PM Eastern Daylight Time	06/01/2015 11:40:36 PM Eastern Daylight Time				07/24/2015 04:47:48 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Preferred Gold without Part D (HMO-POS)	01	02		1			H3305	007	0	2016	Western NY (Rochester/Buffalo)		2	2603	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(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	07/24/2015	2016.01	07/24/2015 04:34:38 PM Eastern Daylight Time	08/04/2015 07:21:11 AM Eastern Daylight Time	08/04/2015 07:21:54 AM Eastern Daylight Time			08/04/2015 08:47:09 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	GoldValue with Part D (HMO-POS)	01	02		1			H3305	015	0	2016	Western NY (Rochester/Buffalo)		2	23206	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(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			
H3305	801	0	1	02	01	H3305_801_0	6		1	05/28/2015	2016.01	05/28/2015 10:01:44 AM Eastern Daylight Time	06/01/2015 11:40:53 PM Eastern Daylight Time				06/01/2015 11:58:15 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	Preferred Gold - Employer Group (HMO-POS)	01	02		1			H3305	801	0	2016	Employer Group West Region		1	1183	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1	2			
H3305	803	0	1	02	01	H3305_803_0	4		1	05/27/2015	2016.01	05/27/2015 04:01:41 PM Eastern Daylight Time	06/01/2015 11:40:58 PM Eastern Daylight Time				06/01/2015 11:58:15 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	Preferred Gold Rx - Employer Group (HMO-POS)	01	02		1			H3305	803	0	2016	Employer Group West Region		1	9260	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1	2			
H3307	002	0	1	01	01	H3307_002_0	3		1	07/31/2015	2016.01	07/31/2015 10:54:34 AM Central Daylight Time	07/31/2015 01:09:29 PM Central Daylight Time	07/30/2015 09:54:21 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3307	002	0	2016	New York City		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	012	0	1	01	01	H3307_012_0	3		1	07/31/2015	2016.01	07/31/2015 10:55:34 AM Central Daylight Time	07/31/2015 01:09:52 PM Central Daylight Time	07/30/2015 09:54:38 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3307	012	0	2016	Rockland, Orange and Westchester 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	2			
H3307	015	0	1	01	01	H3307_015_0	3		1	08/03/2015	2016.01	08/03/2015 10:40:13 AM Central Daylight Time	08/03/2015 01:30:25 PM Central Daylight Time	07/30/2015 09:54:53 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Mosaic (HMO)	01	01		1			H3307	015	0	2016	New York City		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)870-9604		(866)870-9604		(800)555-5757		(800)555-5757		(866)870-9604		(866)870-9604		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	018	0	1	01	01	H3307_018_0	2		1	05/20/2015	2016.01	05/20/2015 01:23:31 PM Central Daylight Time	05/29/2015 02:42:50 PM Central Daylight Time				07/13/2015 01:27:27 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H3307	018	0	2016	NYC and Rockland, Orange, and Westchester 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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3307	023	0	1	01	01	H3307_023_0	3		1	07/31/2015	2016.01	07/31/2015 10:57:47 AM Central Daylight Time	07/31/2015 01:10:39 PM Central Daylight Time	07/30/2015 09:55:11 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3307	023	0	2016	Rockland, Orange, and Westchester 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	2			
H3307	024	0	1	01	01	H3307_024_0	3		1	07/31/2015	2016.01	07/31/2015 10:59:44 AM Central Daylight Time	07/31/2015 01:11:03 PM Central Daylight Time	07/30/2015 09:55:27 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H3307	024	0	2016	NYC Boroughs		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	025	0	1	01	01	H3307_025_0	3		1	07/31/2015	2016.01	07/31/2015 11:00:45 AM Central Daylight Time	07/31/2015 01:11:27 PM Central Daylight Time	07/30/2015 09:55:42 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H3307	025	0	2016	Sullivan and Ulster 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	2			
H3307	802	0	1	01	01	H3307_802_0	2		1	04/13/2015	2016.01	04/13/2015 01:40:33 PM Central Daylight Time	05/29/2015 02:50:27 PM Central Daylight Time				06/01/2015 02:01:06 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	802	0	2016	New York Metropolitan Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H3307	804	0	1	01	01	H3307_804_0	2		1	04/13/2015	2016.01	04/13/2015 01:41:15 PM Central Daylight Time	05/29/2015 02:50:55 PM Central Daylight Time				06/01/2015 02:01:06 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	804	0	2016	New York Metropolitan Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H3307	805	0	1	01	01	H3307_805_0	2		1	04/13/2015	2016.01	04/13/2015 01:41:55 PM Central Daylight Time	05/29/2015 02:45:00 PM Central Daylight Time				06/01/2015 02:01:06 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	805	0	2016	State of New York		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H3312	002	0	1	01	01	H3312_002_0	3		1	07/31/2015	2016.01	07/31/2015 10:43:46 PM Eastern Daylight Time	08/01/2015 08:21:18 AM Eastern Daylight Time	07/29/2015 05:12:45 PM Eastern Daylight Time			08/03/2015 01:26:04 AM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3312	002	0	2016	Bronx, Kings and Richmond Counties		2	6162	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	018	0	1	01	01	H3312_018_0	7		1	08/10/2015	2016.01	08/10/2015 09:02:40 AM Eastern Daylight Time	08/07/2015 01:53:50 PM Eastern Daylight Time	07/29/2015 05:13:04 PM Eastern Daylight Time			08/10/2015 09:27:49 AM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	018	0	2016	Rockland and Westchester Counties		2	2905	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	048	0	1	01	01	H3312_048_0	5		1	07/31/2015	2016.01	07/31/2015 10:46:57 PM Eastern Daylight Time	08/01/2015 09:25:14 AM Eastern Daylight Time	07/29/2015 05:13:23 PM Eastern Daylight Time			08/03/2015 01:26:04 AM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	048	0	2016	Upstate New York		2	2570	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	060	0	1	01	01	H3312_060_0	3		1	07/31/2015	2016.01	07/31/2015 10:49:35 PM Eastern Daylight Time	08/01/2015 09:49:44 AM Eastern Daylight Time	07/29/2015 05:13:42 PM Eastern Daylight Time			08/03/2015 01:26:04 AM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	060	0	2016	New York and Queens Counties		2	2541	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	061	0	1	01	01	H3312_061_0	3		1	07/31/2015	2016.01	07/31/2015 10:51:33 PM Eastern Daylight Time	08/01/2015 09:54:28 AM Eastern Daylight Time	07/29/2015 05:14:01 PM Eastern Daylight Time			08/03/2015 01:26:04 AM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	061	0	2016	Bronx, Kings and Richmond Counties		2	1316	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	801	0	1	01	01	H3312_801_0	2		1	07/16/2015	2016.01	07/16/2015 06:49:16 PM Eastern Daylight Time	07/16/2015 05:25:12 PM Eastern Daylight Time				07/16/2015 07:41:15 PM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3312	801	0	2016	New York		1	1043	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1	2			
H3312	804	0	1	01	01	H3312_804_0	2		1	07/16/2015	2016.01	07/16/2015 06:49:21 PM Eastern Daylight Time	07/16/2015 05:25:12 PM Eastern Daylight Time				07/16/2015 07:41:15 PM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3312	804	0	2016	New York		1	1752	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H3321	001	0	1	20	08	H3321_001_0	1		1	05/26/2015	2016.01	05/26/2015 10:48:24 AM Eastern Daylight Time		05/22/2015 02:57:26 PM Eastern Daylight Time			05/26/2015 11:58:41 AM Eastern Daylight Time	INDEPENDENT LIVING SRVCS OF CENTRAL NY	Independent Living Srvcs Of Central Ny	www.pacecny.org	Loretto Independent Living Services, Inc (PACE)	08	20		1			H3321	001	0	2016	Onondaga County		2		2			2								Independent Living Services of Central New York, Inc	www.loretto-cny.org									(877)208-5284		(315)452-5800		(877)208-5284		(315)452-5800										(877)208-5284		(315)452-5800		(877)208-5284		(315)452-5800																
H3321	003	0	1	20	08	H3321_003_0	1		1	05/26/2015	2016.01	05/26/2015 10:49:04 AM Eastern Daylight Time		05/22/2015 03:04:07 PM Eastern Daylight Time			05/26/2015 11:58:41 AM Eastern Daylight Time	INDEPENDENT LIVING SRVCS OF CENTRAL NY	Independent Living Srvcs Of Central Ny	www.pacecny.org	Loretto Independent Living Services, Inc (PACE)	08	20		1			H3321	003	0	2016	Onondaga County		2		2			2								Independent Living Services of Central New York, Inc	www.loretto-cny.org									(877)208-5284		(315)452-5800		(877)208-5284		(315)452-5800										(877)208-5284		(315)452-5800		(877)208-5284		(315)452-5800																
H3322	001	0	1	20	08	H3322_001_0	2		1	05/20/2015	2016.01	05/20/2015 10:56:48 AM Eastern Daylight Time		05/27/2015 10:17:09 AM Eastern Daylight Time			05/27/2015 12:17:45 PM Eastern Daylight Time	SENIOR CARE CONNECTION, INC.	Eddy SeniorCare	www.nehealth.com/Senior_Services/Senior_Care_PACE/	Senior Care Connection dba Eddy SeniorCare (PACE)	08	20		1			H3322	001	0	2016	Schenectady County, Albany County, NY		2		2			2								www.northeasthealth.com	www.northeasthealth.com									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361															
H3322	002	0	1	20	08	H3322_002_0	2		1	05/20/2015	2016.01	05/20/2015 10:57:20 AM Eastern Daylight Time		05/27/2015 10:26:42 AM Eastern Daylight Time			05/27/2015 12:17:45 PM Eastern Daylight Time	SENIOR CARE CONNECTION, INC.	Eddy SeniorCare	www.nehealth.com/Senior_Services/Senior_Care_PACE/	Senior Care Connection dba:  Eddy SeniorCare (PACE)	08	20		1			H3322	002	0	2016	Schenectady County, Albany County		2		2			2								www.northeasthealth.com	www.northeasthealth.com									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361															
H3327	001	0	1	01	01	H3327_001_0	6		1	08/04/2015	2016.01	08/04/2015 10:04:06 AM Eastern Daylight Time	08/07/2015 01:10:38 PM Eastern Daylight Time	07/30/2015 02:30:36 PM Eastern Daylight Time			08/10/2015 04:11:50 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Power (HMO)	01	01		1			H3327	001	0	2016	New York City and Westchester		2	4021	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3327	002	0	1	01	01	H3327_002_0	6		1	08/04/2015	2016.01	08/04/2015 09:57:57 AM Eastern Daylight Time	08/07/2015 01:10:38 PM Eastern Daylight Time	07/30/2015 02:31:24 PM Eastern Daylight Time			08/10/2015 12:53:04 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Total (HMO)	01	01		1			H3327	002	0	2016	New York City and Westchester		2	4567	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3327	026	0	1	01	01	H3327_026_0	10	2	1	08/04/2015	2016.01	08/04/2015 10:03:49 AM Eastern Daylight Time	08/07/2015 01:10:38 PM Eastern Daylight Time	07/30/2015 02:40:22 PM Eastern Daylight Time			08/10/2015 12:53:04 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Prestige (HMO SNP)	01	01		1			H3327	026	0	2016	Bronx, Queens, Kings Richmond and Westchester		2	1516	2			1	3		1	5			http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3327	043	0	1	01	01	H3327_043_0	9	2	1	08/04/2015	2016.01	08/04/2015 10:02:02 AM Eastern Daylight Time	08/07/2015 01:10:38 PM Eastern Daylight Time	07/30/2015 02:41:36 PM Eastern Daylight Time			08/10/2015 12:53:04 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Grand (HMO SNP)	01	01		1			H3327	043	0	2016	Bronx, Queens, Kings Richmond and Westchester		2	222	2			1	3		1	5			http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3327	801	0	1	01	01	H3327_801_0	4		1	06/05/2015	2016.01	06/05/2015 12:25:09 PM Eastern Daylight Time	06/05/2015 01:25:48 PM Eastern Daylight Time				06/05/2015 03:08:59 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Power (HMO)	01	01		1			H3327	801	0	2016	Employer - New York		1	42	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3327	802	0	1	01	01	H3327_802_0	3		1	06/05/2015	2016.01	06/05/2015 12:19:56 PM Eastern Daylight Time	06/05/2015 01:24:52 PM Eastern Daylight Time				06/05/2015 03:08:59 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Clear (HMO)	01	01		1			H3327	802	0	2016	Employer - New York		1	42	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3327	803	0	1	01	01	H3327_803_0	3		1	06/05/2015	2016.01	06/05/2015 12:20:05 PM Eastern Daylight Time	06/05/2015 01:23:40 PM Eastern Daylight Time				06/05/2015 03:08:59 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Total (HMO)	01	01		1			H3327	803	0	2016	Employer - New York		1	42	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	001	0	1	02	01	H3328_001_0	11		1	07/16/2015	2016.01	07/16/2015 03:06:03 PM Eastern Daylight Time	07/10/2015 04:08:21 PM Eastern Daylight Time				07/16/2015 04:13:26 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage without Rx (HMO-POS)	01	02		1			H3328	001	0	2016	NY Counties		2	141	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707										(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125										2					2					2	2			
H3328	002	0	1	01	01	H3328_002_0	7	2	1	07/16/2015	2016.01	07/16/2015 03:11:25 PM Eastern Daylight Time	07/30/2015 11:40:48 AM Eastern Daylight Time	07/30/2015 11:38:28 AM Eastern Daylight Time			08/04/2015 05:11:44 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Dual Advantage (HMO SNP)	01	01		1			H3328	002	0	2016	NY Counties		2	1750	2			1	3		1	4			www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2	2			
H3328	003	0	1	02	01	H3328_003_0	8		1	08/04/2015	2016.01	08/04/2015 05:05:23 PM Eastern Daylight Time	07/30/2015 11:56:59 AM Eastern Daylight Time	07/30/2015 11:52:59 AM Eastern Daylight Time			08/04/2015 05:11:44 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Flex (HMO-POS)	01	02		1			H3328	003	0	2016	NY Counties		2	17363	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2	2			
H3328	016	0	1	01	01	H3328_016_0	7	2	1	07/16/2015	2016.01	07/16/2015 03:12:11 PM Eastern Daylight Time	07/30/2015 12:22:31 PM Eastern Daylight Time	08/04/2015 02:12:50 AM Eastern Daylight Time			08/04/2015 05:11:44 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicaid Advantage Plus (HMO SNP)	01	01		1			H3328	016	0	2016	NY Counties		2	172	2			1	3		1	4			www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2	2			
H3328	017	0	1	01	01	H3328_017_0	6	2	1	08/04/2015	2016.01	08/04/2015 05:05:53 PM Eastern Daylight Time	07/30/2015 12:38:31 PM Eastern Daylight Time	07/30/2015 12:36:30 PM Eastern Daylight Time			08/04/2015 05:11:44 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Dual Advantage Flex (HMO SNP)	01	01		1			H3328	017	0	2016	NY Counties		2	19614	2			1	3		1	4			www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2	2			
H3328	019	0	1	01	01	H3328_019_0	9		1	08/05/2015	2016.01	08/05/2015 02:16:39 PM Eastern Daylight Time	08/04/2015 05:36:14 PM Eastern Daylight Time	07/31/2015 10:59:56 AM Eastern Daylight Time			08/05/2015 02:54:19 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare $0 Premium (HMO)	01	01		1			H3328	019	0	2016	NY Counties		2	4302	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2	2			
H3328	801	0	1	02	01	H3328_801_0	5		1	05/29/2015	2016.01	05/29/2015 12:27:05 PM Eastern Daylight Time	07/16/2015 01:17:17 PM Eastern Daylight Time				07/16/2015 04:30:07 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Employer without RX (HMO-POS)	01	02		1			H3328	801	0	2016	New York Counties		1	500	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707										(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125										2					2					2	2			
H3328	802	0	1	02	01	H3328_802_0	5		1	05/29/2015	2016.01	05/29/2015 12:27:16 PM Eastern Daylight Time	07/16/2015 01:17:17 PM Eastern Daylight Time				07/16/2015 04:30:07 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Employer (HMO-POS)	01	02		1			H3328	802	0	2016	New York Counties		1	500	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2	2			
H3328	803	0	1	02	01	H3328_803_0	5		1	05/29/2015	2016.01	05/29/2015 12:27:29 PM Eastern Daylight Time	07/16/2015 01:17:17 PM Eastern Daylight Time				07/16/2015 04:30:07 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Employer Non-calendar (HMO-POS)	01	02		1			H3328	803	0	2016	New York Counties		1	500	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2	2			
H3329	001	0	1	20	08	H3329_001_0	1		1	05/26/2015	2016.01	05/26/2015 05:35:18 PM Eastern Daylight Time		05/26/2015 02:15:21 PM Eastern Daylight Time			05/26/2015 05:39:07 PM Eastern Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight Healthcare, Inc.	www.centerlighthealthcare.org	CenterLight Healthcare PACE Dual Eligible (PACE)	08	20		1			H3329	001	0	2016	NYC  and Westchester Counties		2		2			2								N/A	N/A									(877)226-8500		(347)640-6280		(877)226-8500		(347)640-6280										(711)-		(711)-		(711)-		(711)-																
H3329	002	0	1	20	08	H3329_002_0	1		1	05/26/2015	2016.01	05/26/2015 05:35:49 PM Eastern Daylight Time		05/26/2015 02:16:24 PM Eastern Daylight Time			05/26/2015 05:39:07 PM Eastern Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight Healthcare, Inc.	www.centerlighthealthcare.org	CenterLight Healthcare - PACE - Medicare only (PACE)	08	20		1			H3329	002	0	2016	NYC and Westchester Counties		2		2			2								N/A	N/A									(877)226-8500		(347)640-6280		(877)226-8500		(347)640-6280										(711)-		(711)-		(711)-		(711)-																
H3330	021	1	1	01	01	H3330_021_1	6		1	08/05/2015	2016.01	08/05/2015 10:33:51 AM Eastern Daylight Time	08/05/2015 03:34:00 PM Eastern Daylight Time	08/05/2015 03:35:09 PM Eastern Daylight Time			08/05/2015 04:04:46 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP (HMO)	01	01		1			H3330	021	1	2016	Counties of NYC, Westchester and Long Island	Brx,Kings Counties	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	021	2	1	01	01	H3330_021_2	6		1	08/05/2015	2016.01	08/05/2015 10:34:33 AM Eastern Daylight Time	08/05/2015 03:35:25 PM Eastern Daylight Time	08/05/2015 03:35:39 PM Eastern Daylight Time			08/05/2015 04:04:46 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP (HMO)	01	01		1			H3330	021	2	2016	Counties of NYC, Westchester and Long Island	New York City,Queens,Nassau and Rich Counties	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	021	3	1	01	01	H3330_021_3	6		1	08/05/2015	2016.01	08/05/2015 10:37:30 AM Eastern Daylight Time	08/05/2015 03:35:57 PM Eastern Daylight Time	08/05/2015 03:36:10 PM Eastern Daylight Time			08/05/2015 04:04:46 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP (HMO)	01	01		1			H3330	021	3	2016	Counties of NYC, Westchester and Long Island	Suffolk County	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	021	4	1	01	01	H3330_021_4	6		1	08/05/2015	2016.01	08/05/2015 10:37:17 AM Eastern Daylight Time	08/05/2015 03:39:05 PM Eastern Daylight Time	08/05/2015 03:36:52 PM Eastern Daylight Time			08/05/2015 04:04:46 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP (HMO)	01	01		1			H3330	021	4	2016	Counties of NYC, Westchester and Long Island	Westchester County	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	029	0	1	01	01	H3330_029_0	7	2	1	08/04/2015	2016.01	08/04/2015 06:08:51 PM Eastern Daylight Time	08/05/2015 03:37:05 PM Eastern Daylight Time	08/05/2015 03:37:19 PM Eastern Daylight Time			08/05/2015 04:04:46 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Dual Eligible (HMO SNP)	01	01		1			H3330	029	0	2016	Counties of NYC, Westchester and Long Island		2		2			1	3		1	2			www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	1	1	01	01	H3330_032_1	9		1	08/05/2015	2016.01	08/05/2015 10:41:10 AM Eastern Daylight Time	08/05/2015 03:37:38 PM Eastern Daylight Time	08/05/2015 03:37:51 PM Eastern Daylight Time			08/05/2015 04:10:52 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Essential (HMO)	01	01		1			H3330	032	1	2016	Counties of NYC, Westchester and Long Island	Brx,Kings Counties	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	2	1	01	01	H3330_032_2	9		1	08/05/2015	2016.01	08/05/2015 10:39:27 AM Eastern Daylight Time	08/05/2015 03:39:24 PM Eastern Daylight Time	08/05/2015 03:39:54 PM Eastern Daylight Time			08/05/2015 04:10:52 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Essential (HMO)	01	01		1			H3330	032	2	2016	Counties of NYC, Westchester and Long Island	New York City,Queens,Nassau,Rich Counties	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	3	1	01	01	H3330_032_3	9		1	08/05/2015	2016.01	08/05/2015 10:40:08 AM Eastern Daylight Time	08/05/2015 03:40:08 PM Eastern Daylight Time	08/05/2015 03:40:20 PM Eastern Daylight Time			08/05/2015 04:10:52 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Essential (HMO)	01	01		1			H3330	032	3	2016	Counties of NYC, Westchester and Long Island	Suffolk County	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	032	4	1	01	01	H3330_032_4	8		1	08/05/2015	2016.01	08/05/2015 10:40:56 AM Eastern Daylight Time	08/05/2015 03:40:35 PM Eastern Daylight Time	08/05/2015 03:40:56 PM Eastern Daylight Time			08/05/2015 04:10:52 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Essential (HMO)	01	01		1			H3330	032	4	2016	Counties of NYC, Westchester and Long Island	Westchester County	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	033	1	1	01	01	H3330_033_1	6		1	06/03/2015	2016.01	06/03/2015 05:40:21 PM Eastern Daylight Time	08/05/2015 03:41:24 PM Eastern Daylight Time	08/05/2015 03:41:37 PM Eastern Daylight Time			08/05/2015 04:13:08 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP High Option (HMO)	01	01		1			H3330	033	1	2016	Counties of NYC, Westchester and Long Island	Brx and Kings Counties	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	033	2	1	01	01	H3330_033_2	6		1	06/03/2015	2016.01	06/03/2015 05:41:02 PM Eastern Daylight Time	08/05/2015 03:41:51 PM Eastern Daylight Time	08/05/2015 03:42:02 PM Eastern Daylight Time			08/05/2015 04:13:08 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP High Option (HMO)	01	01		1			H3330	033	2	2016	Counties of NYC, Westchester and Long Island	New York City,Queens,Nassau, Rich Counties	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	033	3	1	01	01	H3330_033_3	6		1	06/03/2015	2016.01	06/03/2015 05:41:48 PM Eastern Daylight Time	08/05/2015 03:42:24 PM Eastern Daylight Time	08/05/2015 03:42:40 PM Eastern Daylight Time			08/05/2015 04:13:08 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP High Option (HMO)	01	01		1			H3330	033	3	2016	Counties of NYC, Westchester and Long Island	Suffolk County	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	033	4	1	01	01	H3330_033_4	6		1	06/03/2015	2016.01	06/03/2015 05:42:29 PM Eastern Daylight Time	08/05/2015 03:42:52 PM Eastern Daylight Time	08/05/2015 03:43:04 PM Eastern Daylight Time			08/05/2015 04:13:08 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP High Option (HMO)	01	01		1			H3330	033	4	2016	Counties of NYC, Westchester and Long Island	Westchester County	2		2			2							www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	808	0	2	01	01	H3330_808_0	2		1	06/01/2015	2016.01	06/01/2015 03:25:48 PM Eastern Daylight Time	06/01/2015 09:47:47 AM Eastern Daylight Time				06/01/2015 03:45:08 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Part A Payers (HMO)	01	01		2	1		H3330	808	0	2016	Counties of NYC:, Westchester and Long Island		1		2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	810	0	1	01	01	H3330_810_0	3	2	1	06/01/2015	2016.01	06/01/2015 11:32:38 AM Eastern Daylight Time	06/01/2015 09:48:11 AM Eastern Daylight Time				06/01/2015 12:34:29 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Dual Eligible Group (HMO SNP)	01	01		1			H3330	810	0	2016	Counties of NYC, Westchester and Long Island		1		2			1	3		1	2			www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	814	0	1	01	01	H3330_814_0	3		1	05/29/2015	2016.01	05/29/2015 04:53:18 PM Eastern Daylight Time	05/29/2015 02:54:18 PM Eastern Daylight Time				06/01/2015 12:34:29 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Premier (HMO)	01	01		1			H3330	814	0	2016	Counties of NYC, Nassau, Suffolk, Westchester		1		2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3330	815	0	1	01	01	H3330_815_0	3		1	05/29/2015	2016.01	05/29/2015 04:53:06 PM Eastern Daylight Time	05/29/2015 02:54:31 PM Eastern Daylight Time				06/01/2015 12:34:29 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Rx Carveout (HMO)	01	01		1			H3330	815	0	2016	Counties of NYC, Nassau, Suffolk, Westchester		1		2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3331	001	0	1	20	08	H3331_001_0	1		1	05/20/2015	2016.01	05/20/2015 01:10:52 PM Eastern Daylight Time		05/18/2015 12:04:36 PM Eastern Daylight Time			05/20/2015 01:12:40 PM Eastern Daylight Time	INDEPENDENT LIVING FOR SENIORS, INC.	ElderONE	www.ElderONE.org	Living for Seniors Dually Eligible (PACE)	08	20		1			H3331	001	0	2016	Monroe County		2		2			2								www.rochestergeneral.org	www.rochestergeneral.org/hillhaven									(800)896-0211		(585)922-2831		(800)896-0211		(585)922-2831										(800)896-0211		(585)922-2831		(800)896-0211		(585)922-2831																
H3331	002	0	1	20	08	H3331_002_0	1		1	05/20/2015	2016.01	05/20/2015 01:11:09 PM Eastern Daylight Time		05/18/2015 12:09:20 PM Eastern Daylight Time			05/20/2015 01:12:40 PM Eastern Daylight Time	INDEPENDENT LIVING FOR SENIORS, INC.	ElderONE	www.ElderONE.org	Independent Living for Seniors Care only (PACE)	08	20		1			H3331	002	0	2016	Monroe County		2		2			2								www.rochestergeneral.org	www.rochestergeneral.org/hillhaven									(800)896-0211		(585)922-2831		(800)896-0211		(585)922-2831										(800)896-0211		(585)922-2831		(800)896-0211		(585)922-2831																
H3335	005	0	1	04	01	H3335_005_0	6		1	07/02/2015	2016.01	07/02/2015 03:41:54 PM Eastern Daylight Time	07/31/2015 03:14:22 PM Eastern Daylight Time	07/31/2015 03:14:22 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueSecure (PPO)	01	04		1			H3335	005	0	2016	Utica-Rome Metro		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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	006	0	1	04	01	H3335_006_0	6		1	07/02/2015	2016.01	07/02/2015 03:42:10 PM Eastern Daylight Time	07/31/2015 03:14:22 PM Eastern Daylight Time	07/31/2015 03:14:22 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEnhanced (PPO)	01	04		1			H3335	006	0	2016	Utica-Rome Metro		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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	014	0	1	04	01	H3335_014_0	6		1	07/02/2015	2016.01	07/02/2015 03:42:26 PM Eastern Daylight Time	07/31/2015 03:14:22 PM Eastern Daylight Time	07/31/2015 03:14:22 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueSecure (PPO)	01	04		1			H3335	014	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	015	0	1	04	01	H3335_015_0	6		1	07/02/2015	2016.01	07/02/2015 02:06:46 PM Eastern Daylight Time	07/31/2015 03:14:22 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEnhanced (PPO)	01	04		1			H3335	015	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	018	0	1	04	01	H3335_018_0	5		1	05/23/2015	2016.01	05/23/2015 08:28:06 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BluePlus (PPO)	01	04		1			H3335	018	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	038	0	1	04	01	H3335_038_0	6		1	07/02/2015	2016.01	07/02/2015 03:27:09 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueClassic (PPO)	01	04		1			H3335	038	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	041	0	1	04	01	H3335_041_0	5		1	05/23/2015	2016.01	05/23/2015 08:29:31 PM Eastern Daylight Time	07/06/2015 01:45:08 PM Eastern Daylight Time				07/08/2015 08:33:44 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	01	04		1			H3335	041	0	2016	Utica-Rome Metro		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	043	0	1	04	01	H3335_043_0	4		1	05/23/2015	2016.01	05/23/2015 08:30:24 PM Eastern Daylight Time	05/31/2015 09:58:26 AM Eastern Daylight Time				05/31/2015 08:44:00 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	01	04		1			H3335	043	0	2016	Central New York		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	044	0	1	04	01	H3335_044_0	5		1	05/23/2015	2016.01	05/23/2015 08:30:55 PM Eastern Daylight Time	07/06/2015 01:45:09 PM Eastern Daylight Time				07/08/2015 08:33:44 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	01	04		1			H3335	044	0	2016	East New York		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	051	0	1	04	01	H3335_051_0	6		1	07/02/2015	2016.01	07/02/2015 03:27:39 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueClassic (PPO)	01	04		1			H3335	051	0	2016	Utica-Rome Metro		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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	053	0	1	04	01	H3335_053_0	7		1	07/02/2015	2016.01	07/02/2015 03:33:32 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEssential (PPO)	01	04		1			H3335	053	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	054	0	1	04	01	H3335_054_0	6		1	07/02/2015	2016.01	07/02/2015 03:33:48 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEssential (PPO)	01	04		1			H3335	054	0	2016	Utica-Rome Metro		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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	801	0	1	04	01	H3335_801_0	4		1	05/20/2015	2016.01	05/20/2015 10:01:07 AM Eastern Daylight Time	05/31/2015 08:40:59 PM Eastern Daylight Time				05/31/2015 08:44:00 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	2016	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	811	0	1	04	01	H3335_811_0	5		1	05/31/2015	2016.01	05/31/2015 11:49:51 AM Eastern Daylight Time	05/31/2015 08:40:59 PM Eastern Daylight Time				06/01/2015 08:50:32 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue PPO Group (PPO)	01	04		1			H3335	811	0	2016	Rochester Metro Area and Eastern New York Area		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	813	0	1	04	01	H3335_813_0	4		1	05/14/2015	2016.01	05/14/2015 08:39:23 AM Eastern Daylight Time	05/31/2015 08:40:59 PM Eastern Daylight Time				05/31/2015 08:44:00 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	2016	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	819	0	1	04	01	H3335_819_0	5		1	05/31/2015	2016.01	05/31/2015 11:50:20 AM Eastern Daylight Time	05/31/2015 08:40:59 PM Eastern Daylight Time				06/01/2015 08:50:32 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue PPO Group (PPO)	01	04		1			H3335	819	0	2016	Rochester Metro Area and Eastern New York Area		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2						2			
H3335	820	0	1	04	01	H3335_820_0	5		1	05/31/2015	2016.01	05/31/2015 11:51:23 AM Eastern Daylight Time	05/31/2015 08:40:58 PM Eastern Daylight Time				06/01/2015 08:50:32 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue PPO Group Non-Calendar (PPO)	01	04		1			H3335	820	0	2016	Rochester Metro Area and Eastern New York Area		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3335	822	0	1	04	01	H3335_822_0	4		1	05/14/2015	2016.01	05/14/2015 08:40:33 AM Eastern Daylight Time	05/31/2015 08:40:58 PM Eastern Daylight Time				05/31/2015 08:44:00 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	2016	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2						2			
H3337	001	0	1	01	01	H3337_001_0	9		1	07/30/2015	2016.01	07/30/2015 06:16:05 PM Pacific Daylight Time	07/30/2015 06:05:29 PM Pacific Daylight Time	07/30/2015 01:41:13 PM Pacific Daylight Time			07/31/2015 01:48:14 PM Pacific Daylight Time	LIBERTY HEALTH ADVANTAGE, INC.	Liberty Health Advantage	www.lhany.com	Liberty Health Advantage Preferred Choice (HMO)	01	01		1			H3337	001	0	2016	Bronx, Kings, Nassau, New York, Queens, Richmond		2		2			2							www.lhany.com	www.lhany.com	http://www.lhany.com	(866)542-4269		(866)542-4269		(855)439-1660		(855)439-1660		(800)546-5677		(800)546-5677		(855)439-1660		(855)439-1660		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)706-4757		(866)706-4757		(800)662-1220		(800)662-1220		2					2					2	2			
H3337	003	0	1	01	01	H3337_003_0	9	2	1	07/30/2015	2016.01	07/30/2015 06:16:40 PM Pacific Daylight Time	07/30/2015 06:06:13 PM Pacific Daylight Time	07/30/2015 01:41:13 PM Pacific Daylight Time			07/31/2015 01:48:14 PM Pacific Daylight Time	LIBERTY HEALTH ADVANTAGE, INC.	Liberty Health Advantage	www.lhany.com	Liberty Health Advantage Dual Power (HMO SNP)	01	01		1			H3337	003	0	2016	Bronx, Kings, Nassau, New York, Queens, Richmond		2		2			1	3		1	3		2	www.lhany.com	www.lhany.com	http://www.lhany.com	(866)542-4269		(866)542-4269		(855)439-1660		(855)439-1660		(800)546-5677		(800)546-5677		(855)439-1660		(855)439-1660		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)706-4757		(866)706-4757		(800)662-1220		(800)662-1220		2					2					2	2			
H3342	019	0	1	04	01	H3342_019_0	9		1	07/20/2015	2016.01	07/20/2015 12:08:20 PM Eastern Daylight Time	08/01/2015 09:22:55 PM Eastern Daylight Time	07/30/2015 06:14:29 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Access (PPO)	01	04		1			H3342	019	0	2016	Select Counties in New York		2	3015	2			2							www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(866)395-5175		(866)395-5175		(800)797-6308		(800)797-6308		(866)395-5175		(866)395-5175		(844)364-2114		(844)364-2114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3342	808	0	1	04	01	H3342_808_0	4		1	05/29/2015	2016.01	05/29/2015 12:18:45 PM Pacific Daylight Time	05/31/2015 09:38:33 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	808	0	2016	New York		1	3653	2			2							www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H3342	809	0	1	04	01	H3342_809_0	4		1	05/29/2015	2016.01	05/29/2015 12:18:54 PM Pacific Daylight Time	05/31/2015 09:38:38 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	809	0	2016	New York		1	469	2			2							www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H3342	810	0	1	04	01	H3342_810_0	4		1	05/29/2015	2016.01	05/29/2015 12:18:37 PM Pacific Daylight Time	05/31/2015 01:16:22 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	810	0	2016	New York		1	50	2			2							www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H3344	005	0	1	04	01	H3344_005_0	7		1	07/10/2015	2016.01	07/10/2015 10:25:37 AM Eastern Daylight Time	07/30/2015 09:15:21 AM Eastern Daylight Time	07/30/2015 09:15:49 AM Eastern Daylight Time			08/05/2015 08:11:34 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare Passport Advantage (PPO)	01	04		1			H3344	005	0	2016	Western New York		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independentheatlh.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2						2			
H3344	801	0	1	04	01	H3344_801_0	5		1	06/02/2015	2016.01	06/02/2015 10:42:18 AM Eastern Daylight Time	07/14/2015 11:23:39 AM Eastern Daylight Time				07/16/2015 07:53:00 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare PPO Base (PPO)	01	04		1			H3344	801	0	2016	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independentheatlh.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		1	1	1a;1b;2;5;6;7c;7d;7i;8a;8b1;8b2;9a;9b;10a;11a;11b;11c;15;16b;	2		1						2			
H3344	804	0	1	04	01	H3344_804_0	5		1	05/26/2015	2016.01	05/26/2015 04:37:45 PM Eastern Daylight Time	07/14/2015 11:24:12 AM Eastern Daylight Time				07/16/2015 07:53:00 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare PPO Base (PPO)	01	04		1			H3344	804	0	2016	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independentheatlh.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										1	1	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;9a;9b;10a;11a;11b;11c;14e;15;16b;	2		1						2			
H3347	002	0	1	01	01	H3347_002_0	13	2	1	08/05/2015	2016.01	08/05/2015 08:06:25 PM Eastern Daylight Time	08/05/2015 03:38:22 PM Eastern Daylight Time	08/05/2015 03:38:10 PM Eastern Daylight Time			08/05/2015 08:42:25 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan For Medicaid Beneficiaries (HMO SNP)	01	01		1			H3347	002	0	2016	Brx, Ki, Na, NY, Qu, Suf, Wes		2	4376	2			1	3		1	2			www.elderplan.org	www.elderplan.org	www.envisionrx.com	(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	16		1	08/05/2015	2016.01	08/05/2015 08:30:14 PM Eastern Daylight Time	08/10/2015 12:45:30 PM Eastern Daylight Time	08/05/2015 03:37:52 PM Eastern Daylight Time			08/10/2015 03:58:41 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Advantage For Nursing Home Residents (HMO SNP)	01	01		1			H3347	003	0	2016	Brx, Ki, Monr, Na, NY, Qu, Ri, Suf, Wes		2	479	2			1	1	1	1				www.elderplan.org	www.elderplan.org	www.envisionrx.com	(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	15	2	1	09/21/2015	2016.01	09/21/2015 12:34:58 PM Eastern Daylight Time	08/13/2015 05:48:38 PM Eastern Daylight Time	08/05/2015 03:37:45 PM Eastern Daylight Time			09/21/2015 01:06:26 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Plus Long Term Care (HMO SNP)	01	01		1			H3347	007	0	2016	Brx, Ki, Na, NY, Qu, Ri, Wes		2	815	2			1	3		1	3		2	www.elderplan.org	www.elderplan.org	www.envisionrx.com	(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	009	0	1	01	01	H3347_009_0	17		1	08/10/2015	2016.01	08/10/2015 02:31:15 PM Eastern Daylight Time	08/06/2015 12:52:15 PM Eastern Daylight Time	08/05/2015 03:37:27 PM Eastern Daylight Time			08/14/2015 02:34:43 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Extra Help (HMO)	01	01		1			H3347	009	0	2016	Brx, Ki, Na, NY, Qu, Suf, Wes		2	6278	2			2							www.elderplan.org	www.elderplan.org	www.envisionrx.com	(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	012	0	1	01	01	H3347_012_0	13		1	08/05/2015	2016.01	08/05/2015 08:17:45 PM Eastern Daylight Time	08/05/2015 03:37:39 PM Eastern Daylight Time	08/05/2015 03:37:19 PM Eastern Daylight Time			08/05/2015 08:42:25 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Diabetes Care (HMO SNP)	01	01		1			H3347	012	0	2016	Brx, Ki, Na, NY, Qu, Ri, Suf, Wes		2	14	2			1	4		1		00000010000000000000		www.elderplan.org	www.elderplan.org	www.envisionrx.com	(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	013	0	1	02	01	H3347_013_0	16		1	08/12/2015	2016.01	08/12/2015 08:09:22 AM Eastern Daylight Time	08/05/2015 03:37:22 PM Eastern Daylight Time	08/05/2015 03:37:13 PM Eastern Daylight Time			08/13/2015 09:37:35 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Healthy Balance (HMO-POS)	01	02		1			H3347	013	0	2016	Na, Suf, Wes		2	12	2			2							www.elderplan.org	www.elderplan.org	www.envisionrx.com	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3351	001	0	1	02	01	H3351_001_0	4		1	05/23/2015	2016.01	05/23/2015 08:17:38 PM Eastern Daylight Time	05/31/2015 09:56:26 AM Eastern Daylight Time				05/31/2015 08:44:00 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Select (HMO-POS)	01	02		1			H3351	001	0	2016	Western New York		2		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2	2			
H3351	002	0	1	02	01	H3351_002_0	6		1	07/02/2015	2016.01	07/02/2015 03:54:54 PM Eastern Daylight Time	07/31/2015 03:14:23 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Secure (HMO-POS)	01	02		1			H3351	002	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	006	0	1	02	01	H3351_006_0	6		1	07/02/2015	2016.01	07/02/2015 03:55:52 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Optimum (HMO-POS)	01	02		1			H3351	006	0	2016	Metro Rochester		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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	007	0	1	02	01	H3351_007_0	4		1	05/23/2015	2016.01	05/23/2015 08:19:34 PM Eastern Daylight Time	05/31/2015 09:56:26 AM Eastern Daylight Time				05/31/2015 08:44:00 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Platinum (HMO-POS)	01	02		1			H3351	007	0	2016	Metro Rochester		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2	2			
H3351	010	0	1	01	01	H3351_010_0	5		1	05/23/2015	2016.01	05/23/2015 08:20:02 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Value (HMO)	01	01		1			H3351	010	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	011	0	1	01	01	H3351_011_0	5		1	05/23/2015	2016.01	05/23/2015 08:20:21 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Value (HMO)	01	01		1			H3351	011	0	2016	Metro Rochester		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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	012	0	1	01	01	H3351_012_0	5		1	05/23/2015	2016.01	05/23/2015 08:20:51 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Value Plus (HMO)	01	01		1			H3351	012	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	013	0	1	01	01	H3351_013_0	5		1	05/23/2015	2016.01	05/23/2015 08:21:13 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time	07/31/2015 03:14:24 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Value Plus (HMO)	01	01		1			H3351	013	0	2016	Metro Rochester		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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	015	0	1	02	01	H3351_015_0	7		1	07/02/2015	2016.01	07/02/2015 02:13:10 PM Eastern Daylight Time	07/31/2015 03:14:25 PM Eastern Daylight Time	07/31/2015 03:14:25 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Bassett (HMO-POS)	01	02		1			H3351	015	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)121-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	016	0	1	02	01	H3351_016_0	6		1	07/02/2015	2016.01	07/02/2015 03:56:53 PM Eastern Daylight Time	07/31/2015 03:14:25 PM Eastern Daylight Time	07/31/2015 03:14:25 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Select (HMO-POS)	01	02		1			H3351	016	0	2016	Metro Rochester		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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1200		(800)421-1220		(800)421-1200		(800)421-1220		(800)421-1200		(800)421-1220		(800)421-1200		(800)421-1220		2					2					2	2			
H3351	017	0	1	01	01	H3351_017_0	5		1	05/23/2015	2016.01	05/23/2015 08:23:13 PM Eastern Daylight Time	07/31/2015 03:14:25 PM Eastern Daylight Time	07/31/2015 03:14:25 PM Eastern Daylight Time			07/31/2015 03:25:47 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Basic (HMO)	01	01		1			H3351	017	0	2016	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)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	801	0	1	02	01	H3351_801_0	4		1	05/20/2015	2016.01	05/20/2015 08:55:34 AM Eastern Daylight Time	05/31/2015 08:40:58 PM Eastern Daylight Time				05/31/2015 08:44:00 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	2016	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	802	0	1	02	01	H3351_802_0	4		1	05/20/2015	2016.01	05/20/2015 10:00:45 AM Eastern Daylight Time	05/31/2015 08:40:58 PM Eastern Daylight Time				05/31/2015 08:44:00 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	2016	Metro Rochester		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	803	0	1	02	01	H3351_803_0	4		1	05/14/2015	2016.01	05/14/2015 08:43:13 AM Eastern Daylight Time	05/31/2015 08:40:59 PM Eastern Daylight Time				05/31/2015 08:44:00 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	2016	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2	2			
H3351	804	0	1	02	01	H3351_804_0	4		1	05/20/2015	2016.01	05/20/2015 10:00:41 AM Eastern Daylight Time	05/31/2015 08:40:59 PM Eastern Daylight Time				05/31/2015 08:44:00 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	2016	Metro Rochester		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2	2			
H3351	805	0	1	02	01	H3351_805_0	4		1	05/20/2015	2016.01	05/20/2015 10:00:38 AM Eastern Daylight Time	05/31/2015 08:40:59 PM Eastern Daylight Time				05/31/2015 08:44:00 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	2016	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3351	806	0	1	02	01	H3351_806_0	4		1	05/20/2015	2016.01	05/20/2015 10:00:35 AM Eastern Daylight Time	05/31/2015 08:40:59 PM Eastern Daylight Time				05/31/2015 08:44:00 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	2016	Metro Rochester		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H3359	001	0	1	01	01	H3359_001_0	6		1	07/02/2015	2016.01	07/02/2015 12:24:58 PM Eastern Daylight Time	08/05/2015 01:29:15 PM Eastern Daylight Time	08/05/2015 01:31:34 PM Eastern Daylight Time			08/05/2015 02:36:02 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst 65 Plus Plan (HMO)	01	01		1			H3359	001	0	2016	New York City and Nassau County		2		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	019	0	1	01	01	H3359_019_0	4		1	07/01/2015	2016.01	07/01/2015 12:15:41 PM Eastern Daylight Time	08/05/2015 01:29:35 PM Eastern Daylight Time	08/05/2015 01:31:09 PM Eastern Daylight Time			08/05/2015 02:36:02 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Increased Benefits Plan (HMO)	01	01		1			H3359	019	0	2016	New York City and Nassau County		2		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	021	0	1	01	01	H3359_021_0	7	2	1	08/05/2015	2016.01	08/05/2015 04:14:42 PM Eastern Daylight Time	08/05/2015 01:28:55 PM Eastern Daylight Time	08/05/2015 01:30:54 PM Eastern Daylight Time			08/05/2015 04:43:03 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Life Improvement Plan (HMO SNP)	01	01		1			H3359	021	0	2016	New York City, Nassau and Westchester Counties		2		2			1	3		1	2			www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	027	0	1	01	01	H3359_027_0	4		1	07/02/2015	2016.01	07/02/2015 12:31:55 PM Eastern Daylight Time	06/01/2015 05:22:09 PM Eastern Daylight Time				07/02/2015 02:51:45 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Coordinated Benefits Plan (HMO)	01	01		1			H3359	027	0	2016	New York City and Nassau County		2		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303										(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821										2					2					2	2			
H3359	034	0	1	01	01	H3359_034_0	6	2	1	06/30/2015	2016.01	06/30/2015 10:17:28 AM Eastern Daylight Time	08/05/2015 01:28:25 PM Eastern Daylight Time	08/05/2015 01:30:39 PM Eastern Daylight Time			08/05/2015 02:36:02 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst CompleteCare (HMO SNP)	01	01		1			H3359	034	0	2016	New York City, Nassau, and Westchester Counties		2		2			1	3		1	5			www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	035	0	1	01	01	H3359_035_0	5		1	06/30/2015	2016.01	06/30/2015 05:46:53 PM Eastern Daylight Time	08/05/2015 01:27:31 PM Eastern Daylight Time	08/05/2015 01:30:16 PM Eastern Daylight Time			08/05/2015 02:36:02 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst AssuredCare (HMO SNP)	01	01		1			H3359	035	0	2016	New York City and Nassau County		2		2			1	1	1	1				www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	036	0	1	01	01	H3359_036_0	9		1	07/02/2015	2016.01	07/02/2015 12:39:54 PM Eastern Daylight Time	08/05/2015 01:28:02 PM Eastern Daylight Time	08/05/2015 01:29:55 PM Eastern Daylight Time			08/05/2015 02:36:02 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Mount Sinai Select (HMO)	01	01		1			H3359	036	0	2016	Manhattan		2		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2	1	11	7a;7d;7f;7g;	7f;
H3359	808	0	1	01	01	H3359_808_0	4		1	07/01/2015	2016.01	07/01/2015 12:21:15 PM Eastern Daylight Time	05/31/2015 01:25:42 PM Eastern Daylight Time				07/01/2015 04:06:29 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Employer Group 1 (HMO)	01	01		1			H3359	808	0	2016	United States		1		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare			(888)260-1010				(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	809	0	1	01	01	H3359_809_0	4		1	07/02/2015	2016.01	07/02/2015 12:19:59 PM Eastern Daylight Time	05/31/2015 01:12:04 PM Eastern Daylight Time				07/02/2015 02:51:45 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Employer Group 2 (HMO)	01	01		1			H3359	809	0	2016	United States		1		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare			(888)260-1010				(877)237-1303										(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821										2					2					2	2			
H3361	043	0	1	01	01	H3361_043_0	5	2	1	05/31/2015	2016.01	05/31/2015 09:57:22 AM Eastern Daylight Time	08/03/2015 01:43:53 PM Eastern Daylight Time	08/03/2015 03:54:30 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO SNP)	01	01		1			H3361	043	0	2016	Select Counties in NY		2	2666	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)491-5746		(866)491-5746		(866)527-0056		(866)527-0056		(866)491-5746		(866)491-5746		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H3361	059	0	1	01	01	H3361_059_0	5		1	07/10/2015	2016.01	07/10/2015 01:10:07 PM Eastern Daylight Time	05/31/2015 12:33:04 PM Eastern Daylight Time				07/14/2015 03:54:53 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO)	01	01		1			H3361	059	0	2016	Select Counties in NY		2	417	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056										(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272										2					2					2	2			
H3361	065	0	1	01	01	H3361_065_0	4	2	1	05/31/2015	2016.01	05/31/2015 09:57:39 AM Eastern Daylight Time	08/03/2015 01:45:36 PM Eastern Daylight Time	08/03/2015 03:54:57 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H3361	065	0	2016	Select Counties in NY		2	1891	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(866)482-3363		(866)482-3363		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H3361	099	0	1	01	01	H3361_099_0	5		1	08/01/2015	2016.01	08/01/2015 09:15:16 AM Eastern Daylight Time	08/03/2015 01:46:29 PM Eastern Daylight Time	08/03/2015 03:55:25 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H3361	099	0	2016	Select Counties in NY		2	9514	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H3361	106	0	1	02	01	H3361_106_0	5		1	08/01/2015	2016.01	08/01/2015 09:15:38 AM Eastern Daylight Time	08/03/2015 01:47:16 PM Eastern Daylight Time	08/03/2015 03:55:52 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO-POS)	01	02		1			H3361	106	0	2016	Bronx, Kings, New York, Queens, Richmond Counties		2	6545	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H3361	109	0	1	01	01	H3361_109_0	4	2	1	07/13/2015	2016.01	07/13/2015 07:41:33 AM Eastern Daylight Time	08/03/2015 01:48:07 PM Eastern Daylight Time	08/03/2015 03:56:21 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H3361	109	0	2016	Select Counties in NY		2	15885	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)482-3363		(866)482-3363		(866)527-0056		(866)527-0056		(866)482-3363		(866)482-3363		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H3361	130	0	1	01	01	H3361_130_0	4		1	07/10/2015	2016.01	07/10/2015 01:11:07 PM Eastern Daylight Time	08/03/2015 01:48:56 PM Eastern Daylight Time	08/03/2015 03:56:49 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H3361	130	0	2016	Bronx, Kings, New York, Queens, Richmond Counties		2	6920	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H3361	132	0	1	01	01	H3361_132_0	5		1	08/01/2015	2016.01	08/01/2015 09:16:00 AM Eastern Daylight Time	08/03/2015 01:49:45 PM Eastern Daylight Time	08/03/2015 03:57:16 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO)	01	01		1			H3361	132	0	2016	Nassau County		2	303	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H3361	133	0	1	01	01	H3361_133_0	5		1	08/01/2015	2016.01	08/01/2015 09:16:23 AM Eastern Daylight Time	08/03/2015 01:50:34 PM Eastern Daylight Time	08/03/2015 03:57:44 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO)	01	01		1			H3361	133	0	2016	Ulster County		2	1050	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)278-5155		(800)278-5155		(866)527-0056		(866)527-0056		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H3362	016	0	1	01	01	H3362_016_0	3		1	07/10/2015	2016.01	07/10/2015 10:07:02 AM Eastern Daylight Time	06/01/2015 11:40:36 AM Eastern Daylight Time				07/14/2015 11:06:44 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Encompass 65 (HMO)	01	01		1			H3362	016	0	2016	Western New York		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										2					2					2	2			
H3362	017	0	1	02	01	H3362_017_0	6		1	07/17/2015	2016.01	07/17/2015 11:53:54 AM Eastern Daylight Time	08/10/2015 12:18:08 PM Eastern Daylight Time	07/30/2015 09:18:40 AM Eastern Daylight Time			08/10/2015 12:36:08 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Encompass 65 Basic (HMO-POS)	01	02		1			H3362	017	0	2016	Western New York		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2	2			
H3362	020	0	1	01	01	H3362_020_0	5		1	08/05/2015	2016.01	08/05/2015 11:39:47 AM Eastern Daylight Time	08/04/2015 02:00:35 PM Eastern Daylight Time	07/30/2015 09:21:04 AM Eastern Daylight Time			08/05/2015 08:11:34 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Family Choice (HMO SNP)	01	01		1			H3362	020	0	2016	Western New York		2		2			1	1	3	1				www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2	2			
H3362	026	0	1	02	01	H3362_026_0	5		1	08/10/2015	2016.01	08/10/2015 10:30:43 AM Eastern Daylight Time	08/10/2015 12:19:37 PM Eastern Daylight Time	07/30/2015 09:23:24 AM Eastern Daylight Time			08/10/2015 12:36:08 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Encompass 65 Essential (HMO-POS)	01	02		1			H3362	026	0	2016	Western New York		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2	2			
H3362	027	0	1	01	01	H3362_027_0	5		1	08/05/2015	2016.01	08/05/2015 10:38:28 AM Eastern Daylight Time	08/10/2015 12:22:09 PM Eastern Daylight Time	07/30/2015 09:09:33 AM Eastern Daylight Time			08/10/2015 12:36:08 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Network Advantage (HMO)	01	01		1			H3362	027	0	2016	Erie and Niagara		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2	1	01	9a;9b;	
H3362	029	0	1	02	01	H3362_029_0	5		1	08/05/2015	2016.01	08/05/2015 10:03:11 AM Eastern Daylight Time	08/10/2015 12:21:16 PM Eastern Daylight Time	07/30/2015 09:25:48 AM Eastern Daylight Time			08/10/2015 12:36:08 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Encompass 65 Select (HMO-POS)	01	02		1			H3362	029	0	2016	Counties: Alleg, Catt, Chaut, Gene, Orleans, WY		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2	2			
H3362	801	0	1	01	01	H3362_801_0	2		1	05/27/2015	2016.01	05/27/2015 05:20:54 PM Eastern Daylight Time	06/01/2015 02:43:08 PM Eastern Daylight Time				06/01/2015 02:46:12 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO)	01	01		1			H3362	801	0	2016	New York State		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		1	1	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;9a;9b;10a;11a;11b;11c;14e;15;16b;	2		1					1	2			
H3362	807	0	1	02	01	H3362_807_0	5		1	05/27/2015	2016.01	05/27/2015 05:20:43 PM Eastern Daylight Time	06/05/2015 11:34:06 AM Eastern Daylight Time				06/05/2015 02:24:56 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass POS (HMO-POS)	01	02		1			H3362	807	0	2016	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		1	1	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;9a;9b;10a;11a;11b;11c;14e;15;16b;	2		1	2		2		1	2			
H3362	819	0	1	02	01	H3362_819_0	4		1	05/27/2015	2016.01	05/27/2015 05:20:16 PM Eastern Daylight Time	06/02/2015 03:52:00 PM Eastern Daylight Time				06/02/2015 04:04:11 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass POS (HMO-POS)	01	02		1			H3362	819	0	2016	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										1	1	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;9a;9b;10a;11a;11b;11c;14e;15;16b;	2		1	2		2		1	2			
H3362	820	0	1	01	01	H3362_820_0	2		1	05/27/2015	2016.01	05/27/2015 05:21:08 PM Eastern Daylight Time	06/01/2015 11:52:30 AM Eastern Daylight Time				06/01/2015 02:46:12 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO)	01	01		1			H3362	820	0	2016	New York State		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										1	1	1a;1b;2;5;6;7c;7e;7i;8a;8b1;8b2;9a;9b;10a;11a;11b;11c;14e;15;16b;	2		1					1	2			
H3370	028	0	1	01	01	H3370_028_0	8	2	1	07/06/2015	2016.01	07/06/2015 03:41:04 PM Eastern Daylight Time	08/01/2015 09:23:30 PM Eastern Daylight Time	07/30/2015 07:29:33 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Dual Advantage (HMO SNP)	01	01		1			H3370	028	0	2016	New York City Area		2	8849	2			1	3		1	5			www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(844)309-0305		(844)309-0305		(800)499-9554		(800)499-9554		(844)309-0305		(844)309-0305		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3370	029	1	1	01	01	H3370_029_1	8		1	08/02/2015	2016.01	08/02/2015 11:19:05 AM Eastern Daylight Time	08/03/2015 04:11:11 PM Eastern Daylight Time	07/30/2015 06:15:06 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	029	1	2016	New York City Area in New York	Bronx Plan	2	5027	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3370	029	2	1	01	01	H3370_029_2	8		1	07/31/2015	2016.01	07/31/2015 03:42:32 PM Eastern Daylight Time	08/03/2015 04:11:47 PM Eastern Daylight Time	07/30/2015 06:15:41 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	029	2	2016	New York City Area in New York	Queens	2	17152	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3370	029	3	1	01	01	H3370_029_3	8		1	07/31/2015	2016.01	07/31/2015 03:42:20 PM Eastern Daylight Time	08/03/2015 04:12:21 PM Eastern Daylight Time	07/30/2015 06:16:21 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	029	3	2016	New York City Area in New York	Kings	2	6714	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3370	030	0	1	01	01	H3370_030_0	8		1	07/02/2015	2016.01	07/02/2015 04:34:18 PM Eastern Daylight Time	08/01/2015 09:25:44 PM Eastern Daylight Time	07/30/2015 06:05:52 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	030	0	2016	Metro-North and Mid-Hudson Area in New York		2	9054	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3370	031	0	1	01	01	H3370_031_0	8		1	07/02/2015	2016.01	07/02/2015 04:34:32 PM Eastern Daylight Time	08/01/2015 09:26:16 PM Eastern Daylight Time	07/30/2015 06:16:56 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	031	0	2016	Nassau County in New York		2	5550	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3370	032	0	1	01	01	H3370_032_0	8		1	07/02/2015	2016.01	07/02/2015 04:34:46 PM Eastern Daylight Time	08/01/2015 09:26:49 PM Eastern Daylight Time	07/30/2015 06:17:31 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	032	0	2016	Suffolk County in New York		2	7302	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3370	033	0	1	01	01	H3370_033_0	7		1	07/02/2015	2016.01	07/02/2015 04:34:58 PM Eastern Daylight Time	07/13/2015 06:16:57 PM Eastern Daylight Time				07/13/2015 10:44:39 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Core (HMO)	01	01		1			H3370	033	0	2016	Select Counties in New York		2	564	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3370	035	0	1	01	01	H3370_035_0	8		1	07/31/2015	2016.01	07/31/2015 03:41:59 PM Eastern Daylight Time	08/03/2015 04:12:55 PM Eastern Daylight Time	07/30/2015 06:23:51 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	035	0	2016	New York County		2	888	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3370	801	0	1	01	01	H3370_801_0	4		1	05/30/2015	2016.01	05/30/2015 07:19:36 PM Pacific Daylight Time	05/31/2015 03:03:32 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue (HMO)	01	01		1			H3370	801	0	2016	New York State		1	305	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)564-9053		(800)564-9053		(866)205-6551		(866)205-6551		(800)564-9053		(800)564-9053		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H3370	803	0	1	01	01	H3370_803_0	4		1	05/20/2015	2016.01	05/20/2015 11:42:55 AM Pacific Daylight Time	05/31/2015 03:03:36 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue (HMO)	01	01		1			H3370	803	0	2016	New York State		1	95	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)564-9053		(800)564-9053		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H3379	001	0	1	01	01	H3379_001_0	3		1	07/31/2015	2016.01	07/31/2015 11:01:40 AM Central Daylight Time	07/31/2015 01:45:53 PM Central Daylight Time	07/30/2015 09:56:00 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3379	001	0	2016	New York City		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	002	0	1	01	01	H3379_002_0	2		1	07/31/2015	2016.01	07/31/2015 09:45:37 AM Central Daylight Time	07/31/2015 01:46:17 PM Central Daylight Time	07/30/2015 09:56:18 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3379	002	0	2016	New York Metropolitan area		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	022	0	1	01	01	H3379_022_0	3		1	07/31/2015	2016.01	07/31/2015 09:45:56 AM Central Daylight Time	07/31/2015 01:46:41 PM Central Daylight Time	07/30/2015 09:56:35 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3379	022	0	2016	Upstate New York		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	013	0	1	01	01	H3384_013_0	5		1	07/10/2015	2016.01	07/10/2015 12:50:58 PM Eastern Daylight Time	08/03/2015 04:20:14 PM Eastern Daylight Time	08/03/2015 02:30:52 PM Eastern Daylight Time			08/05/2015 03:11:40 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bsneny.com/medicare	BlueShield Senior Blue HMO 652 PartD (HMO)	01	01		1			H3384	013	0	2016	Northeastern New York		2	2002	2			2							www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	019	0	1	01	01	H3384_019_0	4		1	07/10/2015	2016.01	07/10/2015 02:35:51 PM Eastern Daylight Time	08/03/2015 04:38:18 PM Eastern Daylight Time	08/03/2015 02:37:00 PM Eastern Daylight Time			08/05/2015 03:11:40 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue HMO 651 PartD (HMO)	01	01		1			H3384	019	0	2016	Western New York		2	4551	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	022	0	1	01	01	H3384_022_0	3		1	07/10/2015	2016.01	07/10/2015 01:31:04 PM Eastern Daylight Time	05/29/2015 05:34:55 PM Eastern Daylight Time				07/10/2015 02:37:01 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue HMO 601 (HMO)	01	01		1			H3384	022	0	2016	Western New York		2	1822	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3384	057	0	1	02	01	H3384_057_0	4		1	07/31/2015	2016.01	07/31/2015 11:43:49 AM Eastern Daylight Time	08/03/2015 04:31:12 PM Eastern Daylight Time	08/03/2015 02:35:48 PM Eastern Daylight Time			08/05/2015 03:11:40 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.healthnowny.com/medicare	HealthNow SelectSaver HMO (HMO-POS)	01	02		1			H3384	057	0	2016	Central New York		2	368	2			2							www.healthnowny.com/medicare	www.healthnowny.com/medicare	www.healthnowny.com/medicare	(888)787-2390		(888)787-2390		(888)989-9905		(888)989-9905		(888)787-2390		(888)787-2390		(888)989-9905		(888)989-9905		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	058	0	1	01	01	H3384_058_0	5		1	07/31/2015	2016.01	07/31/2015 03:12:51 PM Eastern Daylight Time	08/03/2015 04:29:44 PM Eastern Daylight Time	08/03/2015 02:35:00 PM Eastern Daylight Time			08/05/2015 03:11:40 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue HMO Select (HMO)	01	01		1			H3384	058	0	2016	Western New York		2	8635	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	059	0	1	02	01	H3384_059_0	4		1	07/31/2015	2016.01	07/31/2015 03:12:47 PM Eastern Daylight Time	08/03/2015 04:28:20 PM Eastern Daylight Time	08/03/2015 02:34:28 PM Eastern Daylight Time			08/05/2015 03:11:40 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bsneny.com/medicare	BlueShield Senior Blue 650 Part D (HMO-POS)	01	02		1			H3384	059	0	2016	Northeastern New York		2	2106	2			2							www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3384	805	0	1	01	01	H3384_805_0	1		1	05/28/2015	2016.01	05/28/2015 03:06:40 PM Eastern Daylight Time	05/29/2015 05:34:55 PM Eastern Daylight Time				05/29/2015 05:46:04 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.nymedicare.com	HMO Group MA Only Plan (HMO)	01	01		1			H3384	805	0	2016	Western and Northeastern New York		1	13	2			2							www.nymedicare.com	http://www.bcbswny.com/pharmacy	www.bcbswny.com	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;7c;7e;7h;7i;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1	2			
H3384	806	0	1	01	01	H3384_806_0	1		1	05/29/2015	2016.01	05/29/2015 11:26:37 AM Eastern Daylight Time	05/29/2015 05:34:55 PM Eastern Daylight Time				05/29/2015 05:46:04 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.nymedicare.com	HMO Group (MA-PD) Calendar Year (HMO)	01	01		1			H3384	806	0	2016	Western and Northeastern New York		1	3813	2			2							www.nymedicare.com	http://www.bcbswny.com/pharmacy	www.bcbswny.com	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;7c;7e;7h;7i;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1	2			
H3387	010	0	1	01	01	H3387_010_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:38:02 AM Central Daylight Time	07/31/2015 01:48:00 PM Central Daylight Time	07/30/2015 09:56:53 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H3387	010	0	2016	Select counties in New York		2		2			1	3		1	5			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	9		1	07/22/2015	2016.01	07/22/2015 01:42:17 PM Eastern Daylight Time	07/17/2015 02:17:41 PM Eastern Daylight Time				07/22/2015 02:35:55 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Choice (HMO)	01	01		1			H3388	001	0	2016	Greater Capital Region of New York State		2	17440	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000										2					2					2	2			
H3388	002	0	1	01	01	H3388_002_0	11		1	08/11/2015	2016.01	08/11/2015 11:35:02 AM Eastern Daylight Time	08/11/2015 01:15:12 PM Eastern Daylight Time	08/11/2015 01:15:11 PM Eastern Daylight Time			08/11/2015 01:57:55 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Choice Rx (HMO)	01	01		1			H3388	002	0	2016	Greater Capital Region of New York State		2	17440	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		2					2					2	2			
H3388	004	0	1	01	01	H3388_004_0	12		1	07/22/2015	2016.01	07/22/2015 01:42:30 PM Eastern Daylight Time	08/11/2015 01:15:11 PM Eastern Daylight Time	08/11/2015 01:15:12 PM Eastern Daylight Time			08/11/2015 01:57:55 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Value Rx (HMO)	01	01		1			H3388	004	0	2016	Greater Capital Region of New York State		2	9950	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		2					2					2	2			
H3388	013	0	1	01	01	H3388_013_0	13		1	08/05/2015	2016.01	08/05/2015 09:35:54 AM Eastern Daylight Time	08/11/2015 01:15:11 PM Eastern Daylight Time	08/11/2015 01:15:12 PM Eastern Daylight Time			08/11/2015 01:57:55 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Basic RX (HMO)	01	01		1			H3388	013	0	2016	Greater Capital Region of New York State		2	1285	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		2					2					2	2			
H3388	801	0	1	01	01	H3388_801_0	5		1	05/19/2015	2016.01	05/19/2015 11:18:18 AM Eastern Daylight Time	06/01/2015 04:55:07 PM Eastern Daylight Time				06/01/2015 05:30:50 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (HMO)	01	01		1			H3388	801	0	2016	Greater Capital Region of New York State		1	240	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(866)289-2319		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;15;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;14d;	1					1	2			
H3388	803	0	1	01	01	H3388_803_0	5		1	05/30/2015	2016.01	05/30/2015 03:01:04 PM Eastern Daylight Time	06/01/2015 04:55:08 PM Eastern Daylight Time				06/01/2015 05:30:50 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (HMO)	01	01		1			H3388	803	0	2016	Greater Capital Region of New York State		1	8700	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(866)289-2319		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;15;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;14d;	1					1	2			
H3388	804	0	1	01	01	H3388_804_0	5		1	05/29/2015	2016.01	05/29/2015 12:58:11 PM Eastern Daylight Time	06/01/2015 04:55:08 PM Eastern Daylight Time				06/01/2015 05:30:50 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare (HMO)	01	01		1			H3388	804	0	2016	Greater Capital Region of New York State		1	350	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;15;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;14d;	1					1	2			
H3404	001	0	1	04	01	H3404_001_0	10		1	08/03/2015	2016.01	08/03/2015 02:04:59 PM Eastern Daylight Time	08/03/2015 07:57:13 PM Eastern Daylight Time	08/03/2015 07:57:14 PM Eastern Daylight Time			08/03/2015 09:52:40 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare PPO Enhanced (PPO)	01	04		1			H3404	001	0	2016	Select North Carolina Counties		2	37990	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2						2			
H3404	801	0	1	04	01	H3404_801_0	3		1	05/15/2015	2016.01	05/15/2015 12:30:33 PM Eastern Daylight Time	05/28/2015 10:48:25 PM Eastern Daylight Time				05/28/2015 11:03:05 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare PPO EGWP Medical Only (PPO)	01	04		1			H3404	801	0	2016	North Carolina Employer Groups		1	0	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037										(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140										1	1	1a;1b;2;5;6;7e;7h;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;	2		1						2			
H3404	803	0	1	04	01	H3404_803_0	3		1	05/15/2015	2016.01	05/15/2015 12:28:07 PM Eastern Daylight Time	05/28/2015 10:48:22 PM Eastern Daylight Time				05/28/2015 11:03:05 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare PPO EGWP (PPO)	01	04		1			H3404	803	0	2016	North Carolina Employer Groups		1	155	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		1	1	1a;1b;2;5;6;7e;7h;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;	2		1						2			
H3421	001	0	1	09	04	H3421_001_0	4		1	07/21/2015	2016.01	07/21/2015 08:39:39 AM Eastern Daylight Time	05/30/2015 11:56:28 AM Eastern Daylight Time				07/21/2015 08:55:09 AM Eastern Daylight Time	AMERICA'S 1ST CHOICE HEALTH PLANS, INC.	America's 1st Choice Health Plans, Inc.	www.Americas1stChoice.com	Patriot (PFFS)	04	09	1	1			H3421	001	0	2016	Select Counties in SC		2	1	2			2								www.americas1stchoice.com	www.americas1stchoice.com	(866)321-3947		(803)748-4533		(866)321-3947		(803)748-4533										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3421	002	0	1	09	04	H3421_002_0	5		1	07/31/2015	2016.01	07/31/2015 12:16:13 PM Eastern Daylight Time	08/04/2015 12:35:58 PM Eastern Daylight Time	08/04/2015 09:28:17 AM Eastern Daylight Time			08/04/2015 08:00:24 PM Eastern Daylight Time	AMERICA'S 1ST CHOICE HEALTH PLANS, INC.	America's 1st Choice Health Plans, Inc.	www.Americas1stChoice.com	Patriot Plus (PFFS)	04	09	1	1			H3421	002	0	2016	Select Counties in SC		2	0	2			2								www.americas1stchoice.com	www.americas1stchoice.com	(866)321-3947		(803)748-4533		(866)321-3947		(803)748-4533		(866)321-3947		(803)748-4533		(866)321-3947		(803)748-4533		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3430	001	0	1	20	08	H3430_001_0	1		1	05/27/2015	2016.01	05/27/2015 09:26:07 AM Eastern Daylight Time		05/26/2015 08:59:19 AM Eastern Daylight Time			05/27/2015 09:39:29 AM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	http://www.suncoastpace.org/	Suncoast PACE, Inc. (PACE)	08	20		1			H3430	001	0	2016	Suncoast PACE, Inc.		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	05/27/2015	2016.01	05/27/2015 09:27:00 AM Eastern Daylight Time		05/26/2015 09:00:33 AM Eastern Daylight Time			05/27/2015 09:39:29 AM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	http://www.suncoastpace.org/	Suncoast PACE, Inc. (PACE)	08	20		1			H3430	002	0	2016	Suncoast PACE, Inc.		2		2			2								http://www.suncoastpace.org/	http://www.suncoastpace.org/									(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062										(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062																
H3447	001	0	1	01	01	H3447_001_0	5		1	08/03/2015	2016.01	08/03/2015 04:21:17 PM Pacific Daylight Time	08/04/2015 02:05:24 PM Pacific Daylight Time	08/03/2015 12:43:50 PM Pacific Daylight Time			08/05/2015 10:27:44 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Local (HMO)	01	01		1			H3447	001	0	2016	Richmond Metropolitan and South of Richmond Area		2	1384	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	003	0	1	01	01	H3447_003_0	5		1	08/03/2015	2016.01	08/03/2015 04:21:50 PM Pacific Daylight Time	08/04/2015 02:07:00 PM Pacific Daylight Time	08/03/2015 12:44:12 PM Pacific Daylight Time			08/05/2015 10:27:44 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue COPD (HMO SNP)	01	01		1			H3447	003	0	2016	Richmond Metropolitan and South of Richmond Area		2	115	2			1	4		1		00000000000100000000			www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	004	0	1	01	01	H3447_004_0	5		1	08/03/2015	2016.01	08/03/2015 04:36:41 PM Pacific Daylight Time	08/04/2015 02:06:36 PM Pacific Daylight Time	08/03/2015 12:44:32 PM Pacific Daylight Time			08/05/2015 10:27:44 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Diabetes (HMO SNP)	01	01		1			H3447	004	0	2016	Richmond Metropolitan and South of Richmond Area		2	524	2			1	4		1		00000010000000000000			www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	005	0	1	01	01	H3447_005_0	5		1	08/03/2015	2016.01	08/03/2015 04:22:45 PM Pacific Daylight Time	08/04/2015 02:05:48 PM Pacific Daylight Time	08/03/2015 12:44:54 PM Pacific Daylight Time			08/05/2015 10:27:44 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Smart Fit (HMO)	01	01		1			H3447	005	0	2016	Richmond Metropolitan and South of Richmond Area		2	124	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	010	0	1	01	01	H3447_010_0	5		1	08/03/2015	2016.01	08/03/2015 04:23:13 PM Pacific Daylight Time	08/04/2015 02:06:12 PM Pacific Daylight Time	07/29/2015 03:09:29 PM Pacific Daylight Time			08/05/2015 10:27:44 AM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Care To You (HMO SNP)	01	01		1			H3447	010	0	2016	Richmond Metropolitan and South of Richmond Area		2	200	2			1	1	3	1					www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	801	0	1	01	01	H3447_801_0	3		1	05/19/2015	2016.01	05/19/2015 11:57:23 AM Pacific Daylight Time	05/29/2015 07:33:49 PM Pacific Daylight Time				05/30/2015 02:44:40 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue EGWP (HMO)	01	01		1			H3447	801	0	2016	Virginia		1	150	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3447	802	0	1	01	01	H3447_802_0	2		1	05/19/2015	2016.01	05/19/2015 05:26:04 PM Pacific Daylight Time	05/29/2015 07:33:27 PM Pacific Daylight Time				05/30/2015 02:44:40 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue EGWP MAPD (HMO)	01	01		1			H3447	802	0	2016	Virginia		1	150	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	803	0	1	01	01	H3447_803_0	2		1	05/19/2015	2016.01	05/19/2015 12:32:46 PM Pacific Daylight Time	05/29/2015 07:34:11 PM Pacific Daylight Time				05/30/2015 02:44:40 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue EGWP MAPD (HMO)	01	01		1			H3447	803	0	2016	Virginia		1	150	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	005	0	1	01	01	H3449_005_0	9		1	07/10/2015	2016.01	07/10/2015 02:55:46 PM Eastern Daylight Time	08/03/2015 07:57:20 PM Eastern Daylight Time	08/03/2015 07:57:23 PM Eastern Daylight Time			08/03/2015 08:17:25 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO Enhanced (HMO)	01	01		1			H3449	005	0	2016	Select North Carolina Counties		2	20499	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2	2			
H3449	012	0	1	01	01	H3449_012_0	6		1	07/08/2015	2016.01	07/08/2015 11:16:24 AM Eastern Daylight Time	07/20/2015 04:27:22 PM Eastern Daylight Time				07/20/2015 05:16:03 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO Medical Only (HMO)	01	01		1			H3449	012	0	2016	Select North Carolina Counties		2	10606	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037										(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140										2					2					2	2			
H3449	013	0	1	01	01	H3449_013_0	9		1	07/08/2015	2016.01	07/08/2015 10:56:16 AM Eastern Daylight Time	08/03/2015 07:57:30 PM Eastern Daylight Time	08/03/2015 07:57:32 PM Eastern Daylight Time			08/03/2015 08:36:05 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO Standard (HMO)	01	01		1			H3449	013	0	2016	Select North Carolina Counties		2	33692	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2	2			
H3449	016	0	1	01	01	H3449_016_0	11		1	07/30/2015	2016.01	07/30/2015 04:11:41 PM Eastern Daylight Time	08/03/2015 07:57:37 PM Eastern Daylight Time	08/03/2015 07:57:38 PM Eastern Daylight Time			08/03/2015 08:43:09 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO Essential (HMO)	01	01		1			H3449	016	0	2016	Selected North Carolina counties		2	1128	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2	2			
H3449	801	0	1	01	01	H3449_801_0	3		1	05/15/2015	2016.01	05/15/2015 12:29:56 PM Eastern Daylight Time	05/28/2015 10:48:00 PM Eastern Daylight Time				05/28/2015 11:03:05 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO EGWP (HMO)	01	01		1			H3449	801	0	2016	North Carolina Employer Groups		1	988	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7e;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;16b;	2		1					2	2			
H3449	805	0	1	01	01	H3449_805_0	3		1	05/15/2015	2016.01	05/15/2015 12:30:20 PM Eastern Daylight Time	05/28/2015 10:47:57 PM Eastern Daylight Time				05/28/2015 11:03:05 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO EGWP Medical Only (HMO)	01	01		1			H3449	805	0	2016	North Carolina Employer Groups		1	0	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037										(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7e;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;16b;	2		1					2	2			
H3471	001	0	1	01	01	H3471_001_0	4		1	07/01/2015	2016.01	07/01/2015 08:04:58 AM Central Daylight Time	08/03/2015 09:35:24 AM Central Daylight Time	08/02/2015 05:04:42 PM Central Daylight Time			08/04/2015 03:41:31 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Companion Rx (HMO)	01	01		1			H3471	001	0	2016	Central Washington		2	4554	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		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H3471	002	0	1	01	01	H3471_002_0	4		1	07/01/2015	2016.01	07/01/2015 08:06:41 AM Central Daylight Time	08/03/2015 09:36:07 AM Central Daylight Time	08/02/2015 05:05:16 PM Central Daylight Time			08/04/2015 03:41:31 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Companion Plus Rx (HMO)	01	01		1			H3471	002	0	2016	Central Washington		2	315	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		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H3471	003	0	1	01	01	H3471_003_0	3		1	07/01/2015	2016.01	07/01/2015 08:08:30 AM Central Daylight Time	05/30/2015 04:16:53 PM Central Daylight Time				07/02/2015 12:59:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Companion HMO (HMO)	01	01		1			H3471	003	0	2016	Central Washington		2	288	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										2					2					2	2			
H3471	004	0	1	01	01	H3471_004_0	4		1	07/01/2015	2016.01	07/01/2015 08:09:02 AM Central Daylight Time	08/03/2015 09:37:32 AM Central Daylight Time	08/02/2015 05:05:50 PM Central Daylight Time			08/04/2015 03:41:31 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Signal Advantage Rx (HMO)	01	01		1			H3471	004	0	2016	South Central Washington		2	1717	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H3471	005	0	1	01	01	H3471_005_0	4		1	07/01/2015	2016.01	07/01/2015 08:10:49 AM Central Daylight Time	08/03/2015 09:38:15 AM Central Daylight Time	08/02/2015 05:06:24 PM Central Daylight Time			08/04/2015 03:41:31 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Signal Advantage Plus Rx (HMO)	01	01		1			H3471	005	0	2016	South Central Washington		2	74	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H3471	006	0	1	01	01	H3471_006_0	3		1	07/01/2015	2016.01	07/01/2015 08:16:40 AM Central Daylight Time	05/30/2015 04:19:03 PM Central Daylight Time				07/02/2015 12:59:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Signal Advantage HMO (HMO)	01	01		1			H3471	006	0	2016	South Central Washington		2	67	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										2					2					2	2			
H3471	007	0	1	01	01	H3471_007_0	4		1	07/01/2015	2016.01	07/01/2015 08:18:37 AM Central Daylight Time	08/03/2015 09:39:43 AM Central Daylight Time	08/02/2015 05:06:58 PM Central Daylight Time			08/04/2015 03:41:31 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Pioneer Rx (HMO)	01	01		1			H3471	007	0	2016	Western Washington		2	352	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6118		(877)795-6118		(877)795-6120		(877)795-6120		(877)795-6118		(877)795-6118		(877)795-6120		(877)795-6120		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H3471	008	0	1	01	01	H3471_008_0	4		1	07/01/2015	2016.01	07/01/2015 08:20:19 AM Central Daylight Time	08/03/2015 09:40:25 AM Central Daylight Time	08/02/2015 05:07:33 PM Central Daylight Time			08/04/2015 03:41:31 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Pioneer Plus Rx (HMO)	01	01		1			H3471	008	0	2016	Western Washington		2	37	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6118		(877)795-6118		(877)795-6120		(877)795-6120		(877)795-6118		(877)795-6118		(877)795-6120		(877)795-6120		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H3471	009	0	1	01	01	H3471_009_0	3		1	07/01/2015	2016.01	07/01/2015 08:22:05 AM Central Daylight Time	05/30/2015 04:21:14 PM Central Daylight Time				07/02/2015 12:59:21 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Pioneer HMO (HMO)	01	01		1			H3471	009	0	2016	Western Washington		2	34	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6118		(877)795-6118		(877)795-6120		(877)795-6120										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										2					2					2	2			
H3471	010	0	1	01	01	H3471_010_0	4		1	07/01/2015	2016.01	07/01/2015 08:24:04 AM Central Daylight Time	08/03/2015 09:41:55 AM Central Daylight Time	08/02/2015 05:08:07 PM Central Daylight Time			08/04/2015 03:41:31 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Companion Basic Rx (HMO)	01	01		1			H3471	010	0	2016	Central Washington		2	233	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		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H3471	012	0	1	01	01	H3471_012_0	4		1	07/01/2015	2016.01	07/01/2015 08:25:39 AM Central Daylight Time	08/03/2015 09:42:38 AM Central Daylight Time	08/02/2015 05:08:41 PM Central Daylight Time			08/04/2015 03:41:31 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Pioneer Basic Rx (HMO)	01	01		1			H3471	012	0	2016	Western Washington		2	117	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6118		(877)795-6118		(877)795-6120		(877)795-6120		(877)795-6118		(877)795-6118		(877)795-6120		(877)795-6120		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H3471	801	0	1	01	01	H3471_801_0	2		1	05/27/2015	2016.01	05/27/2015 08:35:25 AM Central Daylight Time	05/30/2015 04:23:28 PM Central Daylight Time				05/31/2015 09:22:08 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H3471	801	0	2016	Central Washington		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										1	2		2		1					1	2			
H3471	802	0	1	01	01	H3471_802_0	2		1	05/14/2015	2016.01	05/14/2015 09:50:59 AM Central Daylight Time	05/30/2015 04:24:18 PM Central Daylight Time				05/31/2015 09:22:08 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H3471	802	0	2016	Central Washington		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		1	2		2		1					1	2			
H3471	803	0	1	01	01	H3471_803_0	2		1	05/14/2015	2016.01	05/14/2015 09:51:06 AM Central Daylight Time	05/30/2015 04:25:06 PM Central Daylight Time				05/31/2015 09:22:08 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx - non calendar year (HMO)	01	01		1			H3471	803	0	2016	Central Washington		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		1	2		2		1					1	2			
H3473	001	0	1	20	08	H3473_001_0	1		1	05/20/2015	2016.01	05/20/2015 01:17:10 PM Eastern Daylight Time		05/20/2015 11:41:15 AM Eastern Daylight Time			05/20/2015 01:22:40 PM Eastern Daylight Time	CHARLOTTESVILLE AREA RETIREMENT SERVICES, INC.	Blue Ridge PACE	www.riversideonline.com	Blue Ridge PACE Dual (PACE)	08	20		1			H3473	001	0	2016	Blue Ridge PACE Dual		2		2			2								N/A - no formulary	www.riversideonline.com									(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569										(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569																
H3473	002	0	1	20	08	H3473_002_0	1		1	05/20/2015	2016.01	05/20/2015 01:17:25 PM Eastern Daylight Time		05/20/2015 11:42:55 AM Eastern Daylight Time			05/20/2015 01:22:40 PM Eastern Daylight Time	CHARLOTTESVILLE AREA RETIREMENT SERVICES, INC.	Blue Ridge PACE	www.riversideonline.com	Blue Ridge PACE Medicare Only (PACE)	08	20		1			H3473	002	0	2016	Blue Ridge PACE Medicare Only		2		2			2								N/A - no formulary	www.riversideonline.com									(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569										(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569																
H3480	001	0	1	48	05	H3480_001_0	4		1	08/03/2015	2016.01	08/03/2015 02:26:35 PM Eastern Daylight Time					08/03/2015 02:44:21 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus Integrated H3480-001 (Medicare-Medicaid Plan)	05	48		1			H3480	001	0	2016	Select Counties in Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(855)280-4002		(855)280-4002		(800)833-2364		(800)833-2364		(855)280-4002		(855)280-4002		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H3493	001	0	1	20	08	H3493_001_0	1		1	05/21/2015	2016.01	05/21/2015 10:02:08 AM Central Daylight Time		05/21/2015 09:21:52 AM Central Daylight Time			05/21/2015 10:04:37 AM Central Daylight Time	LIFE AT LOURDES, INC.	LIFE at Lourdes	https://www.lourdesnet.org/programs-and-services/l	LIFE at Lourdes, Inc (PACE)	08	20		1			H3493	001	0	2016	LIFE at Lourdes		2		2			2								www.lourdesnet.org	www.lourdesnet.org									(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355										(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355																
H3493	002	0	1	20	08	H3493_002_0	1		1	05/21/2015	2016.01	05/21/2015 10:02:32 AM Central Daylight Time		05/21/2015 09:21:53 AM Central Daylight Time			05/21/2015 10:04:37 AM Central Daylight Time	LIFE AT LOURDES, INC.	LIFE at Lourdes	www.lourdesmed.org	LIFE at Lourdes, Inc (PACE)	08	20		1			H3493	002	0	2016	LIFE at Lourdes		2		2			2								www.lourdesnet.org	www.lourdesnet.org									(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355										(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355																
H3517	001	0	1	20	08	H3517_001_0	1		1	05/26/2015	2016.01	05/26/2015 02:38:23 PM Pacific Daylight Time		05/21/2015 01:16:14 PM Pacific Daylight Time			05/26/2015 02:41:29 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	2016	Redwood Coast PACE-Dual		2		2			2							n/a	www.pharmastarpbm.com	www.pharmastarpbm.com									(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	05/26/2015	2016.01	05/26/2015 02:39:01 PM Pacific Daylight Time		05/21/2015 01:17:19 PM Pacific Daylight Time			05/26/2015 02:41:29 PM Pacific Daylight Time	HUMBOLDT SENIOR RESOURCE CENTER, INC.	Redwood Coast PACE	www.humsenior.org	Redwood Coast PACE-Medicare Only (PACE)	08	20		1			H3517	002	0	2016	Redwood Coast PACE-Medicare Only		2		2			2								www.pharmastarpbm.com	www.pharmastarpbm.com									(707)443-9747		(707)443-9747		(707)443-9747		(707)443-9747										(711)-		(711)-		(711)-		(711)-																
H3528	001	0	1	01	01	H3528_001_0	8		1	08/05/2015	2016.01	08/05/2015 02:34:34 PM Eastern Daylight Time	08/05/2015 02:32:06 PM Eastern Daylight Time	08/05/2015 02:32:07 PM Eastern Daylight Time			08/05/2015 02:51:45 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Prime 1 (HMO)	01	01		1			H3528	001	0	2016	State of Connecticut		2	39350	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	2			
H3528	002	0	1	01	01	H3528_002_0	8		1	06/29/2015	2016.01	06/29/2015 09:45:57 AM Eastern Daylight Time	08/05/2015 02:32:09 PM Eastern Daylight Time	08/05/2015 02:32:10 PM Eastern Daylight Time			08/05/2015 02:51:45 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Prime 3 (HMO)	01	01		1			H3528	002	0	2016	State of Connecticut		2	5150	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	2			
H3528	003	0	1	01	01	H3528_003_0	6		1	06/29/2015	2016.01	06/29/2015 09:46:57 AM Eastern Daylight Time	07/17/2015 09:10:15 AM Eastern Daylight Time				07/17/2015 09:16:53 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Prime 4 (HMO)	01	01		1			H3528	003	0	2016	State of Connecticut		2	1730	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220										(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710										2					2					2	2			
H3528	006	0	1	02	01	H3528_006_0	9		1	08/05/2015	2016.01	08/05/2015 02:37:49 PM Eastern Daylight Time	08/05/2015 02:32:11 PM Eastern Daylight Time	08/05/2015 02:32:12 PM Eastern Daylight Time			08/05/2015 02:51:45 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Option 1 (HMO-POS)	01	02		1			H3528	006	0	2016	State of Connecticut		2	550	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	2			
H3528	008	0	1	02	01	H3528_008_0	8		1	08/05/2015	2016.01	08/05/2015 02:45:42 PM Eastern Daylight Time	08/05/2015 02:32:14 PM Eastern Daylight Time	08/05/2015 02:32:04 PM Eastern Daylight Time			08/05/2015 02:51:45 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Option 3 (HMO-POS)	01	02		1			H3528	008	0	2016	State of Connecticut		2	7780	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2	2			
H3528	801	0	1	01	01	H3528_801_0	7		1	05/29/2015	2016.01	05/29/2015 06:16:54 PM Eastern Daylight Time	06/29/2015 10:01:04 AM Eastern Daylight Time				06/29/2015 10:11:01 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP (HMO)	01	01		1			H3528	801	0	2016	State of Connecticut		1	1180	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;	2		1					1	2			
H3528	805	0	1	01	01	H3528_805_0	7		1	05/29/2015	2016.01	05/29/2015 06:17:58 PM Eastern Daylight Time	06/29/2015 10:01:05 AM Eastern Daylight Time				06/29/2015 10:11:01 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP (HMO)	01	01		1			H3528	805	0	2016	State of Connecticut		1	260	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220										(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710										1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;	2		1					1	2			
H3528	806	0	1	02	01	H3528_806_0	6		1	05/29/2015	2016.01	05/29/2015 06:17:43 PM Eastern Daylight Time	06/29/2015 10:01:05 AM Eastern Daylight Time				06/29/2015 10:11:01 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP (HMO-POS)	01	02		1			H3528	806	0	2016	State of Connecticut		1	600	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;	2		1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;	2		1	2			
H3528	807	0	1	02	01	H3528_807_0	6		1	05/29/2015	2016.01	05/29/2015 06:18:12 PM Eastern Daylight Time	06/29/2015 10:01:06 AM Eastern Daylight Time				06/29/2015 10:11:01 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP (HMO-POS)	01	02		1			H3528	807	0	2016	State of Connecticut		1	110	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220										(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710										1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;	2		1	1	1a;1b;2;3-3;5;6;7e;7h;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;	2		1	2			
H3533	001	0	1	01	01	H3533_001_0	3		1	07/08/2015	2016.01	07/08/2015 02:57:18 PM Eastern Daylight Time	08/03/2015 03:10:35 PM Eastern Daylight Time	07/29/2015 10:55:58 PM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-001 (HMO)	01	01		1			H3533	001	0	2016	Madison, Oneida, Onondaga and Oswego counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	002	0	1	01	01	H3533_002_0	3	2	1	07/08/2015	2016.01	07/08/2015 03:00:08 PM Eastern Daylight Time	08/03/2015 01:50:34 PM Eastern Daylight Time	07/29/2015 10:56:34 PM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H3533-002 (HMO SNP)	01	01		1			H3533	002	0	2016	Select Counties in New York		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	004	0	1	01	01	H3533_004_0	3	2	1	07/08/2015	2016.01	07/08/2015 02:22:02 PM Eastern Daylight Time	08/03/2015 01:48:13 PM Eastern Daylight Time	07/29/2015 10:57:08 PM Eastern Daylight Time			08/04/2015 01:18:10 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H3533-004 (HMO SNP)	01	01		1			H3533	004	0	2016	Select Counties in New York		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	005	0	1	01	01	H3533_005_0	3		1	07/07/2015	2016.01	07/07/2015 03:18:01 PM Eastern Daylight Time	08/03/2015 11:25:18 AM Eastern Daylight Time	07/29/2015 10:57:44 PM Eastern Daylight Time			08/04/2015 01:18:10 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-005 (HMO)	01	01		1			H3533	005	0	2016	Kings and Queens counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 03:02:54 PM Eastern Daylight Time	08/03/2015 11:01:57 AM Eastern Daylight Time	07/29/2015 10:58:20 PM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-006 (HMO)	01	01		1			H3533	006	0	2016	Capital District area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	007	0	1	01	01	H3533_007_0	3		1	07/07/2015	2016.01	07/07/2015 03:18:54 PM Eastern Daylight Time	08/03/2015 11:19:01 AM Eastern Daylight Time	07/29/2015 10:58:54 PM Eastern Daylight Time			08/04/2015 01:18:10 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-007 (HMO)	01	01		1			H3533	007	0	2016	Richmond County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 02:17:19 PM Eastern Daylight Time	08/03/2015 03:11:07 PM Eastern Daylight Time	07/29/2015 10:59:30 PM Eastern Daylight Time			08/04/2015 01:18:10 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-010 (HMO)	01	01		1			H3533	010	0	2016	Nassau and Suffolk (partial) counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 03:05:46 PM Eastern Daylight Time	08/03/2015 01:44:18 PM Eastern Daylight Time	07/29/2015 11:00:06 PM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-013 (HMO)	01	01		1			H3533	013	0	2016	Select Counties in New York		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	017	0	1	01	01	H3533_017_0	3		1	07/07/2015	2016.01	07/07/2015 03:19:14 PM Eastern Daylight Time	08/03/2015 01:32:18 PM Eastern Daylight Time	07/29/2015 11:00:42 PM Eastern Daylight Time			08/04/2015 01:18:10 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-017 (HMO)	01	01		1			H3533	017	0	2016	New York and Bronx counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	020	0	1	01	01	H3533_020_0	3		1	07/08/2015	2016.01	07/08/2015 03:00:03 PM Eastern Daylight Time	08/03/2015 01:34:05 PM Eastern Daylight Time	07/29/2015 11:01:18 PM Eastern Daylight Time			08/04/2015 01:01:02 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-020 (HMO)	01	01		1			H3533	020	0	2016	Southern Tier New York area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	021	0	1	01	01	H3533_021_0	3		1	07/08/2015	2016.01	07/08/2015 02:18:55 PM Eastern Daylight Time	08/03/2015 01:53:14 PM Eastern Daylight Time	07/29/2015 11:01:52 PM Eastern Daylight Time			08/04/2015 01:01:02 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-021 (HMO)	01	01		1			H3533	021	0	2016	Select Counties in New York		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	022	0	1	01	01	H3533_022_0	3	2	1	07/08/2015	2016.01	07/08/2015 02:19:25 PM Eastern Daylight Time	08/03/2015 01:39:50 PM Eastern Daylight Time	07/29/2015 11:02:28 PM Eastern Daylight Time			08/04/2015 01:01:02 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H3533-022 (HMO SNP)	01	01		1			H3533	022	0	2016	Nassau and Suffolk (partial) counties		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/11/2015	2016.01	05/11/2015 02:20:34 PM Eastern Daylight Time	05/29/2015 08:22:37 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H3533	802	0	2016	Select Counties in NY		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H3533	803	0	1	01	01	H3533_803_0	1		1	05/11/2015	2016.01	05/11/2015 02:21:34 PM Eastern Daylight Time	05/29/2015 08:23:05 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H3533	803	0	2016	Select Counties in NY		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H3536	002	0	1	01	01	H3536_002_0	10		1	08/04/2015	2016.01	08/04/2015 11:14:30 AM Eastern Daylight Time	08/04/2015 10:33:53 AM Eastern Daylight Time	07/30/2015 06:21:15 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3536	002	0	2016	Hillsborough and Rockingham Counties		2	692	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)310-2473		(855)310-2473		(844)368-4243		(844)368-4243		(855)310-2473		(855)310-2473		(844)368-4242		(844)368-4242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	003	0	1	01	01	H3536_003_0	9		1	07/16/2015	2016.01	07/16/2015 06:58:39 PM Eastern Daylight Time	08/03/2015 04:14:06 PM Eastern Daylight Time	07/30/2015 06:33:25 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3536	003	0	2016	Cheshire, Merrimack, and Strafford Counties		2	94	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)310-2473		(855)310-2473		(844)368-4243		(844)368-4243		(855)310-2473		(855)310-2473		(844)368-4242		(844)368-4242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	004	0	1	01	01	H3536_004_0	6		1	07/31/2015	2016.01	07/31/2015 02:01:19 PM Eastern Daylight Time	08/01/2015 09:29:05 PM Eastern Daylight Time	07/30/2015 07:44:42 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	01	01		1			H3536	004	0	2016	Select Counties in New Hampshire		2	203	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)310-2473		(855)310-2473		(844)368-4243		(844)368-4243		(855)310-2473		(855)310-2473		(844)368-4242		(844)368-4242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	801	0	1	01	01	H3536_801_0	4		1	05/20/2015	2016.01	05/20/2015 11:42:08 AM Pacific Daylight Time	06/18/2015 03:11:26 PM Pacific Daylight Time				06/18/2015 03:24:37 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H3536	801	0	2016	Select counties in New Hampshire		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H3536	802	0	1	01	01	H3536_802_0	5		1	05/20/2015	2016.01	05/23/2015 08:59:37 PM Pacific Daylight Time	06/18/2015 03:11:35 PM Pacific Daylight Time				06/18/2015 03:24:37 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H3536	802	0	2016	Select Counties in New Hampshire		1	50	2			2							www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H3561	001	0	1	01	01	H3561_001_0	3	2	1	07/31/2015	2016.01	07/31/2015 04:47:04 PM Pacific Daylight Time	08/03/2015 11:46:18 AM Pacific Daylight Time	07/29/2015 05:00:26 PM Pacific Daylight Time			08/03/2015 05:40:40 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	www.healthnet.com/medicare	Health Net Seniority Plus Amber II Premier (HMO SNP)	01	01		1			H3561	001	0	2016	Fresno, CA		2		2			1	3		1	4			www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3561	002	0	1	01	01	H3561_002_0	3		1	07/31/2015	2016.01	07/31/2015 04:46:37 PM Pacific Daylight Time	08/03/2015 11:46:38 AM Pacific Daylight Time	07/29/2015 05:00:38 PM Pacific Daylight Time			08/03/2015 05:40:40 PM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	HEALTH NET COMMUNITY SOLUTIONS, INC.	www.healthnet.com/medicare	Health Net Seniority Plus Sapphire Premier (HMO)	01	01		1			H3561	002	0	2016	Fresno, L.A., Orange, San Diego, San Francisco		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	001	0	1	01	01	H3597_001_0	6		1	08/02/2015	2016.01	08/02/2015 06:45:22 PM Eastern Daylight Time	08/05/2015 10:04:10 AM Eastern Daylight Time	07/29/2015 05:14:20 PM Eastern Daylight Time			08/05/2015 11:08:48 AM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	001	0	2016	Cumberland, York, Sagadahoc		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	005	0	1	01	01	H3597_005_0	3		1	05/29/2015	2016.01	05/29/2015 09:48:37 AM Eastern Daylight Time	08/01/2015 10:01:30 AM Eastern Daylight Time	07/29/2015 05:14:39 PM Eastern Daylight Time			08/02/2015 07:11:15 PM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3597	005	0	2016	Penobscot, Oxford and Piscataquis counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	007	0	1	01	01	H3597_007_0	4		1	08/02/2015	2016.01	08/02/2015 06:45:46 PM Eastern Daylight Time	08/01/2015 10:02:20 AM Eastern Daylight Time	07/29/2015 05:14:57 PM Eastern Daylight Time			08/02/2015 07:11:15 PM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H3597	007	0	2016	Androscoggin and Kennebec county		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	008	0	1	01	01	H3597_008_0	4		1	07/14/2015	2016.01	07/14/2015 05:33:02 PM Eastern Daylight Time	08/01/2015 10:03:24 AM Eastern Daylight Time	07/29/2015 05:15:16 PM Eastern Daylight Time			08/02/2015 07:11:15 PM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H3597	008	0	2016	Franklin, Lincoln, Waldo counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	009	0	1	01	01	H3597_009_0	4		1	07/14/2015	2016.01	07/14/2015 05:33:10 PM Eastern Daylight Time	08/01/2015 10:04:36 AM Eastern Daylight Time	07/29/2015 05:15:35 PM Eastern Daylight Time			08/02/2015 07:11:15 PM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H3597	009	0	2016	Northern Maine		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	801	0	1	01	01	H3597_801_0	2		1	05/29/2015	2016.01	05/29/2015 12:12:31 PM Eastern Daylight Time	07/16/2015 05:25:13 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3597	801	0	2016	Maine		1	16	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1	2			
H3597	802	0	1	01	01	H3597_802_0	2		1	05/29/2015	2016.01	05/29/2015 12:12:47 PM Eastern Daylight Time	07/16/2015 05:25:11 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3597	802	0	2016	Maine		1	18	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H3613	001	0	1	20	08	H3613_001_0	2		1	05/21/2015	2016.01	05/21/2015 12:21:10 PM Eastern Daylight Time		05/20/2015 04:03:46 PM Eastern Daylight Time			05/21/2015 12:22:17 PM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Dual Eligibles (PACE)	08	20		1			H3613	001	0	2016	McGregor PACE Cuyahoga County		2		2			2								http://www.catamaranrx.com/	http://www.catamaranrx.com/									(216)202-1650		(216)202-1650		(216)202-1650		(216)202-1650										(800)325-2223		(800)325-2223		(800)325-2223		(800)325-2223																
H3613	002	0	1	20	08	H3613_002_0	2		1	05/21/2015	2016.01	05/21/2015 12:21:33 PM Eastern Daylight Time		05/20/2015 04:08:16 PM Eastern Daylight Time			05/21/2015 12:22:17 PM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Medicare Only Eligibles (PACE)	08	20		1			H3613	002	0	2016	McGregor PACE Cuyahoga County		2		2			2								http://www.catamaranrx.com/	http://www.catamaranrx.com/									(216)202-1650		(216)202-1650		(216)202-1650		(216)202-1650										(800)325-2223		(800)325-2223		(800)325-2223		(800)325-2223																
H3653	004	0	1	01	01	H3653_004_0	6		1	06/01/2015	2016.01	06/01/2015 09:24:04 AM Eastern Daylight Time	08/07/2015 05:04:27 PM Eastern Daylight Time	08/05/2015 01:25:07 PM Eastern Daylight Time			08/10/2015 10:05:21 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Enhanced Medical and Drug (HMO)	01	01		1			H3653	004	0	2016	Paramount Elite - Enhanced (Northern OH / SE Mich)		2	13494	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		2					2					2	2			
H3653	015	0	1	01	01	H3653_015_0	5		1	08/05/2015	2016.01	08/05/2015 10:22:28 AM Eastern Daylight Time	08/05/2015 01:25:31 PM Eastern Daylight Time	08/05/2015 01:25:07 PM Eastern Daylight Time			08/05/2015 03:04:51 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Standard Medical and Drug (HMO)	01	01		1			H3653	015	0	2016	Paramount Elite - Standard (Northern OH / SE Mich)		2	2706	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		2					2					2	2			
H3653	018	0	1	01	01	H3653_018_0	3		1	05/20/2015	2016.01	05/20/2015 02:47:33 PM Eastern Daylight Time	07/22/2015 12:37:18 PM Eastern Daylight Time				07/28/2015 11:31:31 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Enhanced Medical Only (HMO)	01	01		1			H3653	018	0	2016	Paramount Elite - Medical Only (North OH/ SE Mich)		2	345	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										2					2					2	2			
H3653	803	0	1	01	01	H3653_803_0	3		1	05/20/2015	2016.01	05/20/2015 07:51:00 AM Eastern Daylight Time	07/22/2015 12:46:52 PM Eastern Daylight Time				07/28/2015 11:31:31 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group A/B No Rx (HMO)	01	01		1			H3653	803	0	2016	Paramount Elite - Emp Group A/B No Rx		1	1455	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;9a;9b;9c;10a;11a;11b;15;	2		1					1	2			
H3653	806	0	2	01	01	H3653_806_0	3		1	05/20/2015	2016.01	05/20/2015 08:16:52 AM Eastern Daylight Time	07/22/2015 01:19:38 PM Eastern Daylight Time				07/28/2015 11:31:31 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group B only No Rx (HMO)	01	01		2	2		H3653	806	0	2016	Paramount Elite - Emp Group B only No Rx		1	111	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										2					1					1	2			
H3653	809	0	1	01	01	H3653_809_0	3		1	05/21/2015	2016.01	05/21/2015 02:44:23 PM Eastern Daylight Time	07/22/2015 01:07:58 PM Eastern Daylight Time				07/28/2015 11:31:31 AM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite-Emp Group A/B Rx (HMO)	01	01		1			H3653	809	0	2016	Paramount Elite-Emp Group A/B Rx		1	83	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		1	1	1a;1b;2;5;6;7e;7h;8b1;8b2;9a;9b;9c;10a;11a;11b;15;	2		1					1	2			
H3655	032	0	1	01	01	H3655_032_0	9		1	08/02/2015	2016.01	08/02/2015 04:00:14 PM Eastern Daylight Time	08/02/2015 05:03:03 PM Eastern Daylight Time	07/30/2015 06:07:50 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Essential (HMO)	01	01		1			H3655	032	0	2016	Select Counties in Ohio		2	123528	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	033	0	1	01	01	H3655_033_0	9	2	1	08/03/2015	2016.01	08/03/2015 09:14:28 AM Eastern Daylight Time	08/01/2015 09:29:39 PM Eastern Daylight Time	07/30/2015 07:30:15 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H3655	033	0	2016	Select Counties in Ohio		2	4909	2			1	3		1	1			www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7796		(855)690-7796		(844)316-0358		(844)316-0358		(855)690-7796		(855)690-7796		(844)316-0358		(844)316-0358		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	034	0	1	01	01	H3655_034_0	8		1	07/06/2015	2016.01	07/06/2015 04:18:38 PM Eastern Daylight Time	08/01/2015 09:30:13 PM Eastern Daylight Time	07/30/2015 06:08:27 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H3655	034	0	2016	Select Counties in Ohio		2	5220	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	035	0	1	01	01	H3655_035_0	9		1	07/28/2015	2016.01	07/28/2015 04:18:00 PM Eastern Daylight Time	08/03/2015 04:14:41 PM Eastern Daylight Time	08/03/2015 01:30:45 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Connect (HMO)	01	01		1			H3655	035	0	2016	Select Counties in Ohio		2	2167	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	801	0	1	01	01	H3655_801_0	4		1	05/20/2015	2016.01	05/20/2015 11:43:30 AM Pacific Daylight Time	05/31/2015 03:03:40 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H3655	801	0	2016	Ohio		1	1368	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H3655	803	0	1	01	01	H3655_803_0	4		1	05/20/2015	2016.01	05/20/2015 11:43:47 AM Pacific Daylight Time	05/31/2015 03:03:45 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H3655	803	0	2016	Ohio		1	24	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H3660	028	0	1	02	01	H3660_028_0	12		1	07/30/2015	2016.01	07/30/2015 03:06:34 PM Eastern Daylight Time	08/04/2015 12:33:22 PM Eastern Daylight Time	08/03/2015 05:20:02 PM Eastern Daylight Time			08/05/2015 01:33:36 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	2016	Northeast Ohio		2	2944	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	029	0	1	02	01	H3660_029_0	9		1	07/16/2015	2016.01	07/16/2015 10:43:16 PM Eastern Daylight Time	08/04/2015 12:37:20 PM Eastern Daylight Time	08/03/2015 05:20:42 PM Eastern Daylight Time			08/05/2015 01:33:36 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	2016	Northeast Ohio		2	7929	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	044	0	1	01	01	H3660_044_0	9		1	07/16/2015	2016.01	07/16/2015 10:44:08 PM Eastern Daylight Time	08/04/2015 12:38:06 PM Eastern Daylight Time	08/03/2015 05:21:28 PM Eastern Daylight Time			08/05/2015 01:33:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	01	01		1			H3660	044	0	2016	Northeast Ohio		2	11184	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	047	0	1	01	01	H3660_047_0	9		1	07/16/2015	2016.01	07/16/2015 10:44:21 PM Eastern Daylight Time	08/04/2015 12:39:22 PM Eastern Daylight Time	08/03/2015 05:22:06 PM Eastern Daylight Time			08/05/2015 01:33:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	01	01		1			H3660	047	0	2016	Northwest Ohio		2	1237	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	048	0	1	02	01	H3660_048_0	9		1	07/16/2015	2016.01	07/16/2015 10:43:26 PM Eastern Daylight Time	08/04/2015 12:40:26 PM Eastern Daylight Time	08/03/2015 05:22:52 PM Eastern Daylight Time			08/05/2015 01:33:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Sapphire (HMO-POS)	01	02		1			H3660	048	0	2016	Northwest Ohio		2	281	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	049	0	1	01	01	H3660_049_0	9		1	07/30/2015	2016.01	07/30/2015 03:06:48 PM Eastern Daylight Time	08/04/2015 12:41:10 PM Eastern Daylight Time	08/03/2015 05:23:28 PM Eastern Daylight Time			08/05/2015 01:33:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Topaz (HMO)	01	01		1			H3660	049	0	2016	Northwest Ohio		2	360	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	050	0	1	01	01	H3660_050_0	9		1	07/16/2015	2016.01	07/16/2015 10:44:44 PM Eastern Daylight Time	08/04/2015 12:42:00 PM Eastern Daylight Time	08/03/2015 05:24:00 PM Eastern Daylight Time			08/05/2015 01:33:36 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Topaz (HMO)	01	01		1			H3660	050	0	2016	Northeast Ohio		2	6069	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2	2			
H3660	801	0	1	01	01	H3660_801_0	3		1	05/30/2015	2016.01	05/30/2015 08:55:23 AM Eastern Daylight Time	05/28/2015 12:34:34 PM Eastern Daylight Time				05/30/2015 09:30:51 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	2016	Nationwide Service Area		1	202	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;16b;	2		2					1	2			
H3660	802	0	1	01	01	H3660_802_0	2		1	05/30/2015	2016.01	05/30/2015 08:56:32 AM Eastern Daylight Time	05/28/2015 12:35:16 PM Eastern Daylight Time				05/30/2015 09:30:51 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	2016	Nationwide Service Area		1	3	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;9a;9b;10a;11a;11b;11c;15;16b;	2		2					1	2			
H3660	805	0	1	02	01	H3660_805_0	2		1	05/30/2015	2016.01	05/30/2015 08:58:46 AM Eastern Daylight Time	05/29/2015 11:01:24 AM Eastern Daylight Time				05/30/2015 09:30:51 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	2016	Nationwide Service Area		1	703	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;16b;	2		1	2			
H3660	806	0	1	02	01	H3660_806_0	2		1	05/30/2015	2016.01	05/30/2015 09:00:25 AM Eastern Daylight Time	05/28/2015 12:36:50 PM Eastern Daylight Time				05/30/2015 09:30:51 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	2016	Nationwide Service Area		1	11	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;9a;9b;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;2;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;16b;	2		1	2			
H3664	014	0	1	02	01	H3664_014_0	4		1	07/06/2015	2016.01	07/06/2015 02:47:43 PM Eastern Daylight Time	07/08/2015 01:27:37 PM Eastern Daylight Time				07/08/2015 01:36:48 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Basic - MA Only (HMO-POS)	01	02		1			H3664	014	0	2016	Operating in 12 counties in Northeastern Ohio		2		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460										2					2					2	2			
H3664	017	0	1	02	01	H3664_017_0	6		1	07/31/2015	2016.01	07/31/2015 12:33:05 PM Eastern Daylight Time	07/31/2015 03:33:39 PM Eastern Daylight Time	07/31/2015 03:33:39 PM Eastern Daylight Time			07/31/2015 03:41:43 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Plus (HMO-POS)	01	02		1			H3664	017	0	2016	Operating in 12 counties in Northeastern Ohio		2		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		2					2					2	2			
H3664	020	0	1	02	01	H3664_020_0	6		1	07/31/2015	2016.01	07/31/2015 12:33:34 PM Eastern Daylight Time	07/31/2015 03:33:33 PM Eastern Daylight Time	07/31/2015 03:33:38 PM Eastern Daylight Time			07/31/2015 03:41:43 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Classic (HMO-POS)	01	02		1			H3664	020	0	2016	Operating in 12 counties in Northeastern Ohio		2		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		2					2					2	2			
H3664	021	0	1	02	01	H3664_021_0	5		1	07/31/2015	2016.01	07/31/2015 12:52:13 PM Eastern Daylight Time	07/31/2015 03:33:38 PM Eastern Daylight Time	07/31/2015 03:33:38 PM Eastern Daylight Time			07/31/2015 03:41:43 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Aultimate (HMO-POS)	01	02		1			H3664	021	0	2016	Operating in 12 counties in Northeastern Ohio		2		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		2					2					2	2			
H3664	801	0	1	02	01	H3664_801_0	4		1	04/29/2015	2016.01	04/29/2015 04:23:31 PM Eastern Daylight Time	07/08/2015 01:27:35 PM Eastern Daylight Time				07/08/2015 01:36:48 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	2016	National Service Area		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	1a;1b;8a;10a;11a;	2		1	2		2		1	2			
H3664	802	0	1	02	01	H3664_802_0	4		1	04/29/2015	2016.01	04/29/2015 04:24:28 PM Eastern Daylight Time	07/08/2015 01:27:36 PM Eastern Daylight Time				07/08/2015 01:36:48 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	2016	National Service Area		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460										1	1	1a;1b;8a;10a;11a;	2		1	2		2		1	2			
H3664	803	0	1	02	01	H3664_803_0	4		1	04/29/2015	2016.01	04/29/2015 04:25:10 PM Eastern Daylight Time	07/08/2015 01:27:36 PM Eastern Daylight Time				07/08/2015 01:36:48 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	2016	National Service Area		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	1a;1b;8a;10a;11a;	2		1	2		2		1	2			
H3664	805	0	2	02	01	H3664_805_0	4		1	04/29/2015	2016.01	04/29/2015 04:26:53 PM Eastern Daylight Time	07/08/2015 01:27:36 PM Eastern Daylight Time				07/08/2015 01:36:48 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	primetimehealthplan.com	Part B Only MA-PD (HMO-POS)	01	02		2	2		H3664	805	0	2016	Part B Only MA-PD National Service Area		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	1a;1b;8a;10a;11a;	2		1	2		2		1	2			
H3664	806	0	2	02	01	H3664_806_0	4		1	04/29/2015	2016.01	04/29/2015 04:27:46 PM Eastern Daylight Time	07/08/2015 01:27:37 PM Eastern Daylight Time				07/08/2015 01:36:48 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	primetimehealthplan.com	Part B Only MA (HMO-POS)	01	02		2	2		H3664	806	0	2016	Part B Only MA National Service Area		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460										1	1	1a;1b;8a;10a;11a;	2		1	2		2		1	2			
H3664	807	0	1	02	01	H3664_807_0	4		1	04/29/2015	2016.01	04/29/2015 04:25:50 PM Eastern Daylight Time	07/08/2015 01:27:37 PM Eastern Daylight Time				07/08/2015 01:36:48 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	2016	National Service Area		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	1a;1b;8a;10a;11a;	2		1	2		2		1	2			
H3668	005	0	1	01	01	H3668_005_0	11		1	08/05/2015	2016.01	08/05/2015 09:34:26 AM Eastern Daylight Time	07/30/2015 08:34:48 AM Eastern Daylight Time	07/30/2015 07:31:14 AM Eastern Daylight Time			08/05/2015 09:47:40 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Classic Preferred (HMO)	01	01		1			H3668	005	0	2016	Greater Central Ohio and Dayton Area		2	31256	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	011	0	1	01	01	H3668_011_0	9		1	08/05/2015	2016.01	08/05/2015 09:34:35 AM Eastern Daylight Time	07/30/2015 07:42:40 AM Eastern Daylight Time	07/30/2015 07:30:50 AM Eastern Daylight Time			08/05/2015 09:47:40 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Essential Care (HMO)	01	01		1			H3668	011	0	2016	Greater Central Ohio and Dayton Area		2	10380	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	013	0	1	01	01	H3668_013_0	5		1	07/15/2015	2016.01	07/15/2015 03:57:38 PM Eastern Daylight Time	06/01/2015 06:00:08 PM Eastern Daylight Time				07/16/2015 05:44:09 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Medical Only (HMO)	01	01		1			H3668	013	0	2016	Greater Central Ohio and Dayton Area		2	457	1	1		2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3668	014	0	1	01	01	H3668_014_0	8		1	08/05/2015	2016.01	08/05/2015 09:34:47 AM Eastern Daylight Time	07/30/2015 08:35:38 AM Eastern Daylight Time	07/30/2015 07:30:32 AM Eastern Daylight Time			08/05/2015 09:47:40 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Southeast OH Classic Preferred (HMO)	01	01		1			H3668	014	0	2016	Southeast Ohio		2	2356	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	015	0	1	01	01	H3668_015_0	8		1	08/05/2015	2016.01	08/05/2015 09:34:59 AM Eastern Daylight Time	07/30/2015 07:47:36 AM Eastern Daylight Time	07/30/2015 07:30:14 AM Eastern Daylight Time			08/05/2015 09:47:40 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Southeast OH Essential Care (HMO)	01	01		1			H3668	015	0	2016	Southeast Ohio		2	2964	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	016	0	1	01	01	H3668_016_0	10		1	08/05/2015	2016.01	08/05/2015 09:35:11 AM Eastern Daylight Time	07/30/2015 08:36:26 AM Eastern Daylight Time	07/30/2015 07:29:54 AM Eastern Daylight Time			08/05/2015 09:47:40 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Southwest OH Classic Preferred (HMO)	01	01		1			H3668	016	0	2016	Greater Cincinnati and Champaign County		2	1375	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	017	0	1	01	01	H3668_017_0	8		1	08/05/2015	2016.01	08/05/2015 09:35:23 AM Eastern Daylight Time	07/30/2015 07:50:32 AM Eastern Daylight Time	07/30/2015 07:32:08 AM Eastern Daylight Time			08/05/2015 09:47:40 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Southwest OH Essential Care (HMO)	01	01		1			H3668	017	0	2016	Greater Cincinnati and Champaign County		2	2919	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3668	801	0	1	01	01	H3668_801_0	2		1	05/22/2015	2016.01	05/22/2015 10:01:20 AM Eastern Daylight Time	06/01/2015 08:51:16 PM Eastern Daylight Time				06/01/2015 08:55:21 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Medical Only (HMO)	01	01		1			H3668	801	0	2016	Central, Southeast and Southwest OH		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3668	802	0	1	01	01	H3668_802_0	1		1	05/22/2015	2016.01	05/22/2015 09:48:57 AM Eastern Daylight Time	06/01/2015 06:01:24 PM Eastern Daylight Time				06/01/2015 08:47:10 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Classic (HMO)	01	01		1			H3668	802	0	2016	Central, Southeast and Southwest OH		1	490	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;	2		1					1	2			
H3668	803	0	1	01	01	H3668_803_0	1		1	05/22/2015	2016.01	05/22/2015 10:18:07 AM Eastern Daylight Time	06/01/2015 06:02:02 PM Eastern Daylight Time				06/01/2015 08:47:10 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Custom (HMO)	01	01		1			H3668	803	0	2016	Central, Southeast and Southwest OH		1	180	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;	2		1					1	2			
H3668	804	0	1	01	01	H3668_804_0	1		1	05/22/2015	2016.01	05/22/2015 10:21:17 AM Eastern Daylight Time	06/01/2015 06:04:12 PM Eastern Daylight Time				06/01/2015 08:47:10 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Classic (HMO)	01	01		1			H3668	804	0	2016	Central, Southeast and Southwest OH		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;	2		1					1	2			
H3668	805	0	1	01	01	H3668_805_0	2		1	05/22/2015	2016.01	05/22/2015 10:23:17 AM Eastern Daylight Time	06/01/2015 08:51:24 PM Eastern Daylight Time				06/01/2015 08:55:21 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southeast OH Medical Only (HMO)	01	01		1			H3668	805	0	2016	Southeast Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;11a;	2		1					1	2			
H3668	806	0	1	01	01	H3668_806_0	1		1	05/22/2015	2016.01	05/22/2015 10:25:24 AM Eastern Daylight Time	06/01/2015 06:06:48 PM Eastern Daylight Time				06/01/2015 08:47:10 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southeast OH Classic (HMO)	01	01		1			H3668	806	0	2016	Southeast Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;	2		1					1	2			
H3668	807	0	1	01	01	H3668_807_0	1		1	05/22/2015	2016.01	05/22/2015 10:27:15 AM Eastern Daylight Time	06/01/2015 06:07:54 PM Eastern Daylight Time				06/01/2015 08:47:10 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southeast OH Custom (HMO)	01	01		1			H3668	807	0	2016	Southeast Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;	2		1					1	2			
H3668	808	0	1	01	01	H3668_808_0	2		1	05/22/2015	2016.01	05/22/2015 10:29:16 AM Eastern Daylight Time	06/01/2015 08:51:32 PM Eastern Daylight Time				06/01/2015 08:55:21 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southwest OH Medical Only (HMO)	01	01		1			H3668	808	0	2016	Southwest Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;11a;	2		1					1	2			
H3668	809	0	1	01	01	H3668_809_0	1		1	05/22/2015	2016.01	05/22/2015 10:31:55 AM Eastern Daylight Time	06/01/2015 06:11:06 PM Eastern Daylight Time				06/01/2015 08:47:10 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southwest OH Classic (HMO)	01	01		1			H3668	809	0	2016	Southwest Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;	2		1					1	2			
H3668	810	0	1	01	01	H3668_810_0	1		1	05/22/2015	2016.01	05/22/2015 10:38:32 AM Eastern Daylight Time	06/01/2015 06:12:10 PM Eastern Daylight Time				06/01/2015 08:47:10 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southwest OH Custom (HMO)	01	01		1			H3668	810	0	2016	Southwest Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;	2		1					1	2			
H3672	013	0	1	01	01	H3672_013_0	11		1	07/24/2015	2016.01	07/24/2015 11:42:49 AM Eastern Daylight Time	07/30/2015 05:59:12 PM Eastern Daylight Time	07/29/2015 07:30:24 PM Eastern Daylight Time			07/30/2015 06:11:05 PM Eastern Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Option II (HMO)	01	01		1			H3672	013	0	2016	East Central Ohio		2	3310	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		2					2					2	2			
H3672	014	0	1	01	01	H3672_014_0	9		1	07/24/2015	2016.01	07/24/2015 11:52:07 AM Eastern Daylight Time	07/21/2015 03:13:38 PM Eastern Daylight Time				07/24/2015 12:19:56 PM Eastern Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Option I (HMO)	01	01		1			H3672	014	0	2016	East Central Ohio		2	849	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290										(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291										2					2					2	2			
H3672	017	0	1	01	01	H3672_017_0	7	2	1	07/21/2015	2016.01	07/21/2015 10:42:39 AM Eastern Daylight Time	07/30/2015 05:57:02 PM Eastern Daylight Time	07/29/2015 08:02:54 PM Eastern Daylight Time			07/30/2015 06:11:05 PM Eastern Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare SNP (HMO SNP)	01	01		1			H3672	017	0	2016	East Central Ohio		2	30	2			1	3		1	4			www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		2					2					2	2			
H3672	018	0	1	01	01	H3672_018_0	10		1	07/24/2015	2016.01	07/24/2015 11:44:14 AM Eastern Daylight Time	07/30/2015 05:54:58 PM Eastern Daylight Time	07/30/2015 01:04:36 PM Eastern Daylight Time			07/30/2015 06:11:05 PM Eastern Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Option IV (HMO)	01	01		1			H3672	018	0	2016	East Central Ohio		2	100	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		2					2					2	2			
H3672	019	0	1	01	01	H3672_019_0	8	2	1	07/21/2015	2016.01	07/21/2015 09:52:47 AM Eastern Daylight Time	07/30/2015 05:52:54 PM Eastern Daylight Time	07/30/2015 01:08:14 PM Eastern Daylight Time			07/30/2015 06:11:05 PM Eastern Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare SNP (HMO SNP)	01	01		1			H3672	019	0	2016	Southeastern Ohio, West Virginia		2	300	2			1	3		1	4			www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		2					2					2	2			
H3672	020	0	1	01	01	H3672_020_0	12		1	07/24/2015	2016.01	07/24/2015 11:52:22 AM Eastern Daylight Time	07/30/2015 05:50:40 PM Eastern Daylight Time	07/30/2015 01:15:46 PM Eastern Daylight Time			07/30/2015 06:11:05 PM Eastern Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Option II (HMO)	01	01		1			H3672	020	0	2016	Southeastern OH, West Virginia		2	7000	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		2					2					2	2			
H3672	021	0	1	01	01	H3672_021_0	7		1	07/24/2015	2016.01	07/24/2015 11:52:40 AM Eastern Daylight Time	07/21/2015 03:13:31 PM Eastern Daylight Time				07/24/2015 12:19:56 PM Eastern Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Option I (HMO)	01	01		1			H3672	021	0	2016	Southeastern OH, West Virginia		2	600	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915										(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919										2					2					2	2			
H3672	023	0	1	01	01	H3672_023_0	8		1	07/24/2015	2016.01	07/24/2015 11:49:55 AM Eastern Daylight Time	07/30/2015 05:47:58 PM Eastern Daylight Time	07/30/2015 01:17:30 PM Eastern Daylight Time			07/30/2015 06:11:05 PM Eastern Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare Capitol Plan (HMO)	01	01		1			H3672	023	0	2016	Kanawha County, West Virginia		2	300	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7917		(800)622-3925		(740)695-7917		(800)622-3925		(740)695-7917		(800)622-3925		(740)695-7917		2					2					2	1	01	8a1;8b1;8b3;9a;9b;	
H3672	805	0	1	01	01	H3672_805_0	5		1	05/27/2015	2016.01	05/27/2015 12:05:44 PM Eastern Daylight Time	07/21/2015 03:13:36 PM Eastern Daylight Time				07/21/2015 03:15:01 PM Eastern Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Employer (HMO)	01	01		1			H3672	805	0	2016	East Central Ohio		1	1500	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;16b;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8b1;8b2;8b3;9a;9b;9c;12;16b;	1					1	2			
H3706	001	0	1	01	01	H3706_001_0	9		1	08/07/2015	2016.01	08/07/2015 09:29:05 AM Central Daylight Time	08/05/2015 03:31:15 PM Central Daylight Time	08/05/2015 03:31:14 PM Central Daylight Time			08/07/2015 10:52:19 AM Central Daylight Time	GENERATIONS HEALTHCARE, INC.	Generations Healthcare	www.globalhealth.com/generations	Generations Healthcare Classic (HMO)	01	01		1			H3706	001	0	2016	Oklahoma		2	6350	2			2							www.globalhealth-medicare.com/search.aspx	www.globalhealth.com/generations_materials.aspx	www.globalhealth-medicare.com/search.aspx	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	009	0	1	01	01	H3706_009_0	6		1	07/06/2015	2016.01	07/06/2015 01:55:11 PM Central Daylight Time	07/23/2015 09:07:20 PM Central Daylight Time				07/23/2015 10:21:26 PM Central Daylight Time	GENERATIONS HEALTHCARE, INC.	Generations Healthcare	www.globalhealth.com/generations	Generations Healthcare Value (HMO)	01	01		1			H3706	009	0	2016	Oklahoma		2	160	2			2							www.globalhealth-medicare.com/search.aspx	www.GenerationsHealthcare.cc	www.globalhealth-medicare.com/search.aspx	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3706	803	0	1	01	01	H3706_803_0	4		1	05/06/2015	2016.01	05/06/2015 12:14:21 PM Central Daylight Time	07/23/2015 09:07:20 PM Central Daylight Time				07/23/2015 10:21:26 PM Central Daylight Time	GENERATIONS HEALTHCARE, INC.	Generations Healthcare	www.globalhealth.com/generations	Generations Healthcare EGHP CY (HMO)	01	01		1			H3706	803	0	2016	Oklahoma		1	1600	2			2							www.globalhealth-medicare.com/search.aspx	www.globalhealth.com/generations_materials.aspx	www.globalhealth-medicare.com/search.aspx	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3706	804	0	1	01	01	H3706_804_0	3		1	05/06/2015	2016.01	05/06/2015 12:14:33 PM Central Daylight Time	07/23/2015 09:06:07 PM Central Daylight Time				07/23/2015 10:21:26 PM Central Daylight Time	GENERATIONS HEALTHCARE, INC.	Generations Healthcare	www.globalhealth.com/generations	Generations Healthcare EGHP Non CY (HMO)	01	01		1			H3706	804	0	2016	Oklahoma		1	0	2			2							www.globalhealth-medicare.com/search.aspx	www.globalhealth.com/generations_materials.aspx	www.globalhealth-medicare.com/search.aspx	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3706	807	0	1	01	01	H3706_807_0	3		1	05/06/2015	2016.01	05/06/2015 12:14:44 PM Central Daylight Time	07/23/2015 09:06:07 PM Central Daylight Time				07/23/2015 10:21:26 PM Central Daylight Time	GENERATIONS HEALTHCARE, INC.	Generations Healthcare	www.globalhealth.com/generations	Generations Healthcare EGHP MA only (HMO)	01	01		1			H3706	807	0	2016	Oklahoma		1	75	2			2							www.globalhealth-medicare.com/search.aspx	www.GenerationsHealthcare.cc	www.globalhealth-medicare.com/search.aspx	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3708	001	0	1	01	01	H3708_001_0	7		1	07/15/2015	2016.01	07/15/2015 03:30:06 PM Central Daylight Time	08/04/2015 10:48:24 AM Central Daylight Time	08/04/2015 10:48:45 AM Central Daylight Time			08/04/2015 12:14:35 PM Central Daylight Time	OKLAHOMA SUPERIOR SELECT, INC.	Tribute Health Plan of Oklahoma	www.tributehealthplans.com	Tribute (HMO SNP)	01	01		1			H3708	001	0	2016	Greater Ardmore Metro Area		2	398	2			1	1	2	1				www.tributehealthplans.com	www.tributehealthplans.com	www.tributehealthplans.com	(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3749	001	0	1	01	01	H3749_001_0	3		1	07/31/2015	2016.01	07/31/2015 11:03:36 AM Central Daylight Time	07/31/2015 01:49:37 PM Central Daylight Time	07/30/2015 03:26:22 PM Central Daylight Time			08/03/2015 04:42:00 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H3749	001	0	2016	Oklahoma City area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3749	017	0	1	01	01	H3749_017_0	3		1	07/31/2015	2016.01	07/31/2015 11:05:14 AM Central Daylight Time	07/31/2015 01:50:09 PM Central Daylight Time	07/30/2015 09:57:13 AM Central Daylight Time			08/03/2015 04:42:00 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H3749	017	0	2016	Tulsa area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3749	018	0	1	01	01	H3749_018_0	3		1	07/31/2015	2016.01	07/31/2015 11:06:39 AM Central Daylight Time	07/31/2015 01:50:42 PM Central Daylight Time	07/30/2015 09:57:30 AM Central Daylight Time			08/03/2015 04:42:00 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H3749	018	0	2016	Oklahoma City area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3749	801	0	1	01	01	H3749_801_0	1		1	04/13/2015	2016.01	04/13/2015 01:48:35 PM Central Daylight Time	05/29/2015 04:03:17 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	801	0	2016	OK Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H3749	803	0	1	01	01	H3749_803_0	1		1	04/13/2015	2016.01	04/13/2015 01:49:02 PM Central Daylight Time	05/29/2015 04:03:42 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	803	0	2016	OK Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H3749	804	0	1	01	01	H3749_804_0	1		1	04/13/2015	2016.01	04/13/2015 01:49:44 PM Central Daylight Time	05/29/2015 04:04:09 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	804	0	2016	OK Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H3755	001	0	1	01	01	H3755_001_0	5		1	07/24/2015	2016.01	07/24/2015 08:57:25 AM Central Daylight Time	08/05/2015 09:30:05 AM Central Daylight Time	08/05/2015 09:30:13 AM Central Daylight Time			08/05/2015 09:44:47 AM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Platinum (HMO)	01	01		1			H3755	001	0	2016	Tulsa Metro Area		2	18000	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2	2			
H3755	002	0	1	01	01	H3755_002_0	3		1	07/09/2015	2016.01	07/09/2015 01:39:54 PM Central Daylight Time	06/01/2015 04:45:47 PM Central Daylight Time				07/10/2015 08:57:17 AM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Silver (HMO)	01	01		1			H3755	002	0	2016	Tulsa Metro Area		2	2546	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(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	5		1	08/03/2015	2016.01	08/03/2015 08:49:03 AM Central Daylight Time	08/05/2015 09:30:13 AM Central Daylight Time	08/05/2015 09:30:13 AM Central Daylight Time			08/05/2015 09:44:47 AM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Platinum Plus (HMO)	01	01		1			H3755	004	0	2016	Tulsa Metro Area		2	5839	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2	2			
H3755	005	0	1	01	01	H3755_005_0	7		1	08/03/2015	2016.01	08/03/2015 08:53:43 AM Central Daylight Time	08/05/2015 09:30:14 AM Central Daylight Time	08/05/2015 09:30:14 AM Central Daylight Time			08/05/2015 09:44:47 AM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Silver Plus (HMO)	01	01		1			H3755	005	0	2016	Tulsa Metro Area		2	689	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(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	2		1	05/31/2015	2016.01	05/31/2015 02:39:15 PM Central Daylight Time	06/01/2015 04:45:49 PM Central Daylight Time				06/01/2015 05:00:40 PM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health EGHP+D (HMO)	01	01		1			H3755	801	0	2016	Tulsa Metro Area		1	2465	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(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			
H3765	001	0	1	01	01	H3765_001_0	5		1	07/13/2015	2016.01	07/13/2015 08:31:09 AM Central Daylight Time	07/29/2015 04:18:58 PM Central Daylight Time	07/29/2015 02:07:16 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	HEARTLANDPLAINS HEALTH	HeartlandPlains Health	www.heartlandplainshealth.com	Classic Plus Rx (HMO)	01	01		1			H3765	001	0	2016	Lincoln - Omaha Metropolitan Areas		2	1264	2			2							www.heartlandplainshealth.com	www.heartlandplainshealth.com	www.heartlandplainshealth.com	(866)792-0184		(866)792-0184		(866)792-0184		(866)792-0184		(866)792-0184		(866)792-0184		(866)792-0184		(866)792-0184		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3794	001	0	1	01	01	H3794_001_0	3		1	05/15/2015	2016.01	05/15/2015 02:32:33 PM Central Daylight Time	07/31/2015 12:47:44 PM Central Daylight Time	07/30/2015 09:57:48 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3794	001	0	2016	Kenosha and Rock counties		2		2			1	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			
H3794	002	0	1	01	01	H3794_002_0	3	2	1	05/26/2015	2016.01	05/26/2015 08:34:04 AM Central Daylight Time	07/31/2015 12:48:18 PM Central Daylight Time	07/30/2015 09:58:06 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO SNP)	01	01		1			H3794	002	0	2016	Select Counties in Wisconsin		2		2			1	3		1	5			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			
H3794	003	0	1	01	01	H3794_003_0	3		1	05/29/2015	2016.01	05/29/2015 10:48:34 AM Central Daylight Time	07/31/2015 12:48:51 PM Central Daylight Time	07/30/2015 09:58:21 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO SNP)	01	01		1			H3794	003	0	2016	Select Counties in Wisconsin		2		2			1	1	2	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			
H3805	001	0	1	01	01	H3805_001_0	3		1	07/31/2015	2016.01	07/31/2015 12:34:33 PM Central Daylight Time	07/31/2015 01:12:50 PM Central Daylight Time	07/30/2015 09:58:36 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3805	001	0	2016	Clackamas, Marion, Multnomah, Polk, Washington		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	007	0	1	01	01	H3805_007_0	3		1	07/31/2015	2016.01	07/31/2015 12:34:04 PM Central Daylight Time	07/31/2015 01:13:25 PM Central Daylight Time	07/30/2015 09:58:51 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3805	007	0	2016	Benton, Lane, and Linn counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	012	0	1	01	01	H3805_012_0	3		1	07/31/2015	2016.01	07/31/2015 12:36:36 PM Central Daylight Time	07/31/2015 01:13:59 PM Central Daylight Time	07/30/2015 09:59:07 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	012	0	2016	Clackamas, Marion, Multnomah, Polk, Washington		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	013	0	1	01	01	H3805_013_0	3		1	07/31/2015	2016.01	07/31/2015 12:38:10 PM Central Daylight Time	07/31/2015 01:14:34 PM Central Daylight Time	07/30/2015 09:59:25 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	013	0	2016	Benton, Lane, and Linn counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	014	0	1	01	01	H3805_014_0	3		1	07/31/2015	2016.01	07/31/2015 12:46:19 PM Central Daylight Time	07/31/2015 01:15:11 PM Central Daylight Time	07/30/2015 09:59:42 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3805	014	0	2016	Select counties in western Washington		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	015	0	1	01	01	H3805_015_0	3		1	07/31/2015	2016.01	07/31/2015 12:49:38 PM Central Daylight Time	07/31/2015 01:15:46 PM Central Daylight Time	07/30/2015 09:59:58 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H3805	015	0	2016	Select counties in western Washington		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	016	0	1	01	01	H3805_016_0	3		1	07/31/2015	2016.01	07/31/2015 01:02:05 PM Central Daylight Time	07/31/2015 01:16:22 PM Central Daylight Time	07/30/2015 10:00:14 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	016	0	2016	Clark and Cowlitz counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	017	0	1	01	01	H3805_017_0	3		1	07/31/2015	2016.01	07/31/2015 01:01:50 PM Central Daylight Time	07/31/2015 01:16:58 PM Central Daylight Time	07/30/2015 10:00:30 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	017	0	2016	King county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	018	0	1	01	01	H3805_018_0	4		1	07/31/2015	2016.01	07/31/2015 01:01:34 PM Central Daylight Time	07/31/2015 01:17:34 PM Central Daylight Time	07/30/2015 10:00:46 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	018	0	2016	Thurston county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	019	0	1	01	01	H3805_019_0	3		1	07/31/2015	2016.01	07/31/2015 01:05:17 PM Central Daylight Time	07/31/2015 01:18:10 PM Central Daylight Time	07/30/2015 10:01:02 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	019	0	2016	Pierce County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	020	0	1	01	01	H3805_020_0	3		1	07/31/2015	2016.01	07/31/2015 01:05:33 PM Central Daylight Time	07/31/2015 01:18:47 PM Central Daylight Time	07/30/2015 10:01:18 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	020	0	2016	Snohomish county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	801	0	1	01	01	H3805_801_0	1		1	04/13/2015	2016.01	04/13/2015 01:51:04 PM Central Daylight Time	05/29/2015 04:11:47 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	801	0	2016	OR Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3805	803	0	1	01	01	H3805_803_0	1		1	04/13/2015	2016.01	04/13/2015 01:52:03 PM Central Daylight Time	05/29/2015 04:12:12 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	803	0	2016	OR Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3805	804	0	1	01	01	H3805_804_0	1		1	04/13/2015	2016.01	04/13/2015 01:53:14 PM Central Daylight Time	05/29/2015 04:12:38 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	804	0	2016	OR Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3805	805	0	1	01	01	H3805_805_0	1		1	04/23/2015	2016.01	04/23/2015 02:59:38 PM Central Daylight Time	05/29/2015 04:13:03 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	805	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3805	806	0	1	01	01	H3805_806_0	1		1	04/23/2015	2016.01	04/23/2015 03:01:09 PM Central Daylight Time	05/29/2015 04:13:29 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	806	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3805	807	0	1	01	01	H3805_807_0	1		1	04/23/2015	2016.01	04/23/2015 03:00:59 PM Central Daylight Time	05/29/2015 04:13:54 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	807	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3809	001	0	1	20	08	H3809_001_0	1		1	05/29/2015	2016.01	05/29/2015 09:10:12 AM Pacific Daylight Time		05/29/2015 08:54:30 AM Pacific Daylight Time			05/29/2015 09:11:41 AM Pacific Daylight Time	PROVIDENCE HEALTH & SERVICES - OREGON	Providence ElderPlace Portland	www.providence.org/elderplace	Providence ElderPlace Portland (dual) (PACE)	08	20		1			H3809	001	0	2016	Multnomah and Washington Counties		2		2			2								http://oregon.providence.org/our-services/p/providence-elderplace-prescription-medications/	http://oregon.providence.org/our-services/p/providence-long-term-care-pharmacy-for-clinicians-hp/ove									(855)415-6048		(503)215-6556		(855)415-6048		(503)215-6556										(800)848-4442		(503)215-6556		(800)848-4442		(503)215-6556																
H3809	002	0	1	20	08	H3809_002_0	1		1	05/29/2015	2016.01	05/29/2015 09:10:40 AM Pacific Daylight Time		05/29/2015 08:55:23 AM Pacific Daylight Time			05/29/2015 09:11:41 AM Pacific Daylight Time	PROVIDENCE HEALTH & SERVICES - OREGON	Providence ElderPlace Portland	www.providence.org/elderplace	Providence ElderPlace Portland (pvt pay) (PACE)	08	20		1			H3809	002	0	2016	Multnomah and Washington Counties		2		2			2								http://oregon.providence.org/our-services/p/providence-elderplace-prescription-medications/	http://oregon.providence.org/our-services/p/providence-long-term-care-pharmacy-for-clinicians-hp/ove									(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	07/16/2015	2016.01	07/16/2015 10:02:16 AM Pacific Daylight Time	06/01/2015 02:28:29 PM Pacific Daylight Time				07/16/2015 10:05:51 AM Pacific Daylight Time	MID ROGUE INDEPENDENT PHYSICIAN ASSOCIATION	AllCare Advantage	www.allcareadvantagehp.com	AllCare Advantage Gold (HMO)	01	01		1			H3810	001	0	2016	Counties:  JO, JA, DO*		2	518	2			2							www.allcareadvantagehp.com/provider-directory	www.allcareadvantagehp.com/formulary	www.allcareadvantagehp.com/pharmacy-directory	(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2	2			
H3810	003	0	1	01	01	H3810_003_0	7		1	07/30/2015	2016.01	07/30/2015 03:23:58 PM Pacific Daylight Time	07/30/2015 03:13:07 PM Pacific Daylight Time	07/30/2015 03:13:14 PM Pacific Daylight Time			07/31/2015 08:53:48 AM Pacific Daylight Time	MID ROGUE INDEPENDENT PHYSICIAN ASSOCIATION	AllCare Advantage	www.allcareadvantagehp.com	AllCare Advantage Gold Plus Rx (HMO)	01	01		1			H3810	003	0	2016	Counties: JO, JA, DO*		2	1598	2			2							www.allcareadvantagehp.com/provider-directory	www.allcareadvantagehp.com/formulary	www.allcareadvantagehp.com/pharmacy-directory	(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3811	001	0	1	01	01	H3811_001_0	3		1	05/29/2015	2016.01	05/29/2015 11:32:57 AM Pacific Daylight Time	05/28/2015 04:28:58 PM Pacific Daylight Time				05/29/2015 02:44:14 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealth.org/medicare	Samaritan Advantage Conventional Plan (HMO)	01	01		1			H3811	001	0	2016	Benton, Lincoln and Linn county		2		2			2							www.samhealth.org/Medicare	www.samhealth.org/Medicare	www.samhealth.org/Medicare	(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	10		1	07/31/2015	2016.01	07/31/2015 09:04:40 AM Pacific Daylight Time	08/04/2015 01:33:44 PM Pacific Daylight Time	08/04/2015 01:33:54 PM Pacific Daylight Time			08/04/2015 01:45:56 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealth.org/medicare	Samaritan Advantage Premier Plan (HMO)	01	01		1			H3811	002	0	2016	Benton, Lincoln and Linn county		2	1546	2			2							www.samhealth.org/Medicare	www.samhealth.org/Medicare	www.samhealth.org/Medicare	(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	7	2	1	07/31/2015	2016.01	07/31/2015 02:46:28 PM Pacific Daylight Time	08/04/2015 01:33:44 PM Pacific Daylight Time	08/04/2015 01:33:54 PM Pacific Daylight Time			08/04/2015 01:45:56 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealth.org/medicare	Samaritan Advantage Special Needs Plan (HMO SNP)	01	01		1			H3811	003	0	2016	Benton, Linn and Lincoln county		2		2			1	3		1	3		2	www.samhealth.org/Medicare	www.samhealth.org/Medicare	www.samhealth.org/Medicare	(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	11		1	07/31/2015	2016.01	07/31/2015 09:09:08 AM Pacific Daylight Time	08/04/2015 01:33:45 PM Pacific Daylight Time	08/04/2015 01:33:54 PM Pacific Daylight Time			08/04/2015 01:45:56 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealth.org/medicare	Samaritan Advantage Premier Plan Plus (HMO)	01	01		1			H3811	009	0	2016	Benton, Lincoln, and Linn Counties		2		2			2							www.samhealth.org/Medicare	www.samhealth.org/Medicare	www.samhealth.org/Medicare	(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	3		1	07/07/2015	2016.01	07/07/2015 09:43:55 AM Pacific Daylight Time	05/29/2015 04:25:06 PM Pacific Daylight Time				07/07/2015 09:58:48 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPO (PPO)	01	04		1			H3813	001	0	2016	State of Oregon		2	1000	2			2							www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3813	006	0	1	04	01	H3813_006_0	5		1	07/07/2015	2016.01	07/07/2015 09:44:42 AM Pacific Daylight Time	07/31/2015 10:15:27 AM Pacific Daylight Time	07/31/2015 10:15:27 AM Pacific Daylight Time			07/31/2015 10:18:55 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPORX (PPO)	01	04		1			H3813	006	0	2016	State of Oregon		2	2000	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	802	0	1	04	01	H3813_802_0	2		1	07/07/2015	2016.01	07/07/2015 09:06:17 AM Pacific Daylight Time	05/29/2015 04:24:45 PM Pacific Daylight Time				07/07/2015 10:04:10 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPORX Employer Option (PPO)	01	04		1			H3813	802	0	2016	State of Oregon		1	7000	2			2							www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9061		(503)265-4762		(877)299-9061		(503)265-4762		(888)786-7509		(503)265-4709		(888)786-7509		(503)265-4709		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3814	007	0	1	01	01	H3814_007_0	7	2	1	08/04/2015	2016.01	08/04/2015 02:48:32 PM Pacific Daylight Time	08/04/2015 04:25:48 PM Pacific Daylight Time	08/03/2015 09:48:06 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Special Needs Plan (HMO SNP)	01	01		1			H3814	007	0	2016	Douglas and Klamath Counties		2	2077	2			1	3		1	3		2	www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					2	2			
H3814	029	0	1	01	01	H3814_029_0	6	2	1	08/04/2015	2016.01	08/04/2015 02:48:48 PM Pacific Daylight Time	08/04/2015 04:26:02 PM Pacific Daylight Time	08/03/2015 09:47:54 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Special Needs Plan (Rogue) (HMO SNP)	01	01		1			H3814	029	0	2016	Josephine and Jackson Counties		2	189	2			1	3		1	3		2	www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					2	2			
H3815	001	0	1	01	01	H3815_001_0	7		1	08/04/2015	2016.01	08/04/2015 02:05:57 PM Pacific Daylight Time	07/31/2015 04:56:00 PM Pacific Daylight Time	07/31/2015 01:39:56 PM Pacific Daylight Time			08/04/2015 02:35:38 PM Pacific Daylight Time	CITIZENS CHOICE HEALTH PLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	My Choice Plan (HMO)	01	01		1			H3815	001	0	2016	LA, North OC, SB, RIV		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	006	0	1	01	01	H3815_006_0	7		1	08/04/2015	2016.01	08/04/2015 02:06:49 PM Pacific Daylight Time	07/31/2015 04:58:46 PM Pacific Daylight Time	07/31/2015 01:40:40 PM Pacific Daylight Time			08/04/2015 02:35:38 PM Pacific Daylight Time	CITIZENS CHOICE HEALTH PLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	My Choice Plan (HMO)	01	01		1			H3815	006	0	2016	Stanislaus, San Joaquin		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	007	0	1	01	01	H3815_007_0	7		1	08/04/2015	2016.01	08/04/2015 11:18:18 AM Pacific Daylight Time	07/31/2015 05:00:28 PM Pacific Daylight Time	07/31/2015 01:41:08 PM Pacific Daylight Time			08/04/2015 02:35:38 PM Pacific Daylight Time	CITIZENS CHOICE HEALTH PLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	My Choice Plan (HMO)	01	01		1			H3815	007	0	2016	Santa Clara		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	008	0	1	01	01	H3815_008_0	6		1	08/04/2015	2016.01	08/04/2015 11:19:14 AM Pacific Daylight Time	07/31/2015 05:02:12 PM Pacific Daylight Time	07/31/2015 01:41:42 PM Pacific Daylight Time			08/04/2015 02:35:38 PM Pacific Daylight Time	CITIZENS CHOICE HEALTH PLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	Platinum Plan (HMO)	01	01		1			H3815	008	0	2016	LA/Orange		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	009	0	1	01	01	H3815_009_0	6		1	08/04/2015	2016.01	08/04/2015 02:20:22 PM Pacific Daylight Time	08/04/2015 10:04:32 AM Pacific Daylight Time	07/31/2015 01:42:22 PM Pacific Daylight Time			08/04/2015 02:35:38 PM Pacific Daylight Time	CITIZENS CHOICE HEALTH PLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	CalPlus Plan (HMO)	01	01		1			H3815	009	0	2016	Riv, SanB, Sta, San Joaquin, Santa Clara, LA, OC		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	010	0	1	01	01	H3815_010_0	7		1	08/04/2015	2016.01	08/04/2015 11:19:55 AM Pacific Daylight Time	07/31/2015 05:08:06 PM Pacific Daylight Time	07/31/2015 01:43:18 PM Pacific Daylight Time			08/04/2015 02:35:38 PM Pacific Daylight Time	CITIZENS CHOICE HEALTH PLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	Heart & Diabetes (HMO SNP)	01	01		1			H3815	010	0	2016	LA/OC		2	1000	2			1	4		1		00000000000000000010		www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	011	0	1	01	01	H3815_011_0	8		1	08/04/2015	2016.01	08/04/2015 02:04:26 PM Pacific Daylight Time	07/31/2015 05:04:42 PM Pacific Daylight Time	07/31/2015 01:44:10 PM Pacific Daylight Time			08/04/2015 02:35:38 PM Pacific Daylight Time	CITIZENS CHOICE HEALTH PLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	AllCare Preferred Plan (HMO)	01	01		1			H3815	011	0	2016	Stanislaus		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	012	0	1	01	01	H3815_012_0	9		1	08/04/2015	2016.01	08/04/2015 11:22:33 AM Pacific Daylight Time	07/31/2015 05:06:26 PM Pacific Daylight Time	07/31/2015 01:45:00 PM Pacific Daylight Time			08/04/2015 02:35:38 PM Pacific Daylight Time	CITIZENS CHOICE HEALTH PLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	Heritage Preferred Choice (HMO)	01	01		1			H3815	012	0	2016	SB/RIV		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(888)979-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3817	007	1	1	04	01	H3817_007_1	5		1	06/30/2015	2016.01	06/30/2015 11:01:41 AM Mountain Daylight Time	07/07/2015 11:55:11 AM Mountain Daylight Time				07/07/2015 03:27:15 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H3817	007	1	2016	Select Counties in Oregon/Clark Co, WA	Metro	2	1832	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3817	007	2	1	04	01	H3817_007_2	5		1	06/30/2015	2016.01	06/30/2015 11:01:52 AM Mountain Daylight Time	07/07/2015 11:55:21 AM Mountain Daylight Time				07/07/2015 03:27:15 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H3817	007	2	2016	Select Counties in Oregon/Clark Co, WA	Non-Metro	2	2620	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3817	008	1	1	04	01	H3817_008_1	6		1	06/30/2015	2016.01	06/30/2015 11:02:03 AM Mountain Daylight Time	08/04/2015 03:00:00 PM Mountain Daylight Time	08/05/2015 04:25:02 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H3817	008	1	2016	Select Counties in Oregon/Clark Co, WA	Metro	2	13549	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	008	2	1	04	01	H3817_008_2	6		1	06/30/2015	2016.01	06/30/2015 11:02:14 AM Mountain Daylight Time	08/04/2015 03:00:40 PM Mountain Daylight Time	08/05/2015 04:25:21 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H3817	008	2	2016	Select Counties in Oregon/Clark Co, WA	Non-Metro	2	18347	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	009	1	1	04	01	H3817_009_1	7		1	06/30/2015	2016.01	06/30/2015 11:02:26 AM Mountain Daylight Time	08/04/2015 02:52:54 PM Mountain Daylight Time	08/05/2015 04:25:39 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H3817	009	1	2016	Select Counties in Oregon/Clark Co, WA	Metro	2	5474	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	009	2	1	04	01	H3817_009_2	7		1	06/30/2015	2016.01	06/30/2015 11:03:59 AM Mountain Daylight Time	08/04/2015 02:53:34 PM Mountain Daylight Time	08/05/2015 04:25:57 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H3817	009	2	2016	Select Counties in Oregon/Clark Co, WA	Non-Metro	2	6059	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3817	801	0	1	04	01	H3817_801_0	5		1	06/09/2015	2016.01	06/09/2015 10:01:08 AM Mountain Daylight Time	07/07/2015 11:56:18 AM Mountain Daylight Time				07/07/2015 03:27:15 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H3817	801	0	2016	Nationwide except territories		1	1000	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;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;12;15;	2		1						2			
H3817	802	0	1	04	01	H3817_802_0	5		1	06/09/2015	2016.01	06/09/2015 10:01:28 AM Mountain Daylight Time	07/07/2015 11:56:33 AM Mountain Daylight Time				07/07/2015 03:27:15 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H3817	802	0	2016	Nationwide except territories		1	1000	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;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;12;15;	2		1						2			
H3818	002	0	1	01	01	H3818_002_0	7	2	1	08/04/2015	2016.01	08/04/2015 08:54:02 AM Pacific Daylight Time	08/03/2015 10:58:52 AM Pacific Daylight Time	07/29/2015 01:59:17 PM Pacific Daylight Time			08/04/2015 12:51:37 PM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycarehealthplans.org	FamilyCare Community (HMO SNP)	01	01		1			H3818	002	0	2016	Portland Metro Clatsop Morrow Umatilla Counties		2	3795	2			1	3		1	3		1	www.familycarehealthplans.org	www.familycarehealthplans.org	www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(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			
H3818	003	0	1	01	01	H3818_003_0	8		1	08/04/2015	2016.01	08/04/2015 08:38:29 AM Pacific Daylight Time	08/03/2015 10:59:17 AM Pacific Daylight Time	07/29/2015 01:59:28 PM Pacific Daylight Time			08/04/2015 12:51:37 PM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycarehealthplans.org	FamilyCare Advantage Rx (HMO)	01	01		1			H3818	003	0	2016	Portland Metro Clatsop Morrow Umatilla Counties		2	1721	2			2							www.familycarehealthplans.org	www.familycarehealthplans.org	www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(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			
H3818	004	0	1	01	01	H3818_004_0	7		1	07/10/2015	2016.01	07/10/2015 01:29:01 PM Pacific Daylight Time	06/04/2015 01:28:42 PM Pacific Daylight Time				07/11/2015 08:03:46 AM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycarehealthplans.org	FamilyCare Select (HMO)	01	01		1			H3818	004	0	2016	Portland Metro Clatsop Morrow Umatilla Counties		2	62	2			2							www.familycarehealthplans.org	http://www.familycarehealthplans.org	http://www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2	2			
H3818	014	0	1	01	01	H3818_014_0	9		1	07/10/2015	2016.01	07/10/2015 01:31:53 PM Pacific Daylight Time	08/03/2015 10:59:40 AM Pacific Daylight Time	07/29/2015 01:59:42 PM Pacific Daylight Time			08/04/2015 12:51:37 PM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	familycarehealthplans.org	FamilyCare Select Rx (HMO)	01	01		1			H3818	014	0	2016	Portland Metro Clatsop Morrow Umatilla Counties		2	253	2			2							www.familycarehealthplans.org	www.familycarehealthplans.org	www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(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			
H3822	001	0	1	01	01	H3822_001_0	7		1	07/15/2015	2016.01	07/15/2015 04:55:27 PM Central Daylight Time	08/03/2015 03:30:40 PM Central Daylight Time	08/03/2015 02:26:36 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	001	0	2016	Cook, DuPage, Will and Kane counties		2	6011	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	002	0	1	01	01	H3822_002_0	6		1	07/24/2015	2016.01	07/24/2015 11:01:27 AM Central Daylight Time	08/03/2015 03:31:14 PM Central Daylight Time	08/03/2015 02:25:34 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicarenm.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	002	0	2016	Bernalillo, Sandoval, Torrence and Valencia cntys		2		2			2							www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	003	0	1	01	01	H3822_003_0	6		1	07/16/2015	2016.01	07/16/2015 12:44:48 PM Central Daylight Time	08/03/2015 03:31:50 PM Central Daylight Time	08/03/2015 02:27:48 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicarenm.com	Blue Cross Medicare Advantage Premier (HMO)	01	01		1			H3822	003	0	2016	Bernalillo, Sandoval, Torrence, Valencia cnty		2		2			2							www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	006	0	1	01	01	H3822_006_0	6	2	1	08/04/2015	2016.01	08/04/2015 10:18:03 AM Central Daylight Time	08/03/2015 03:32:24 PM Central Daylight Time	08/03/2015 02:31:46 PM Central Daylight Time			08/04/2015 02:36:03 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicarenm.com	Blue Cross Medicare Advantage Dual Care (HMO SNP)	01	01		1			H3822	006	0	2016	Bernalillo, Sandoval, Torrance and Valencia		2	500	2			1	3		1	4			www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	007	0	1	02	01	H3822_007_0	7		1	07/17/2015	2016.01	07/17/2015 10:37:03 AM Central Daylight Time	08/03/2015 03:33:00 PM Central Daylight Time	08/03/2015 02:32:28 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com	Blue Cross Medicare Advantage Basic Plus (HMO-POS)	01	02		1			H3822	007	0	2016	Cook, DuPage, Kane and Will counties		2	3028	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	008	0	1	02	01	H3822_008_0	9		1	07/15/2015	2016.01	07/15/2015 04:57:04 PM Central Daylight Time	08/03/2015 03:33:34 PM Central Daylight Time	08/03/2015 02:30:10 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H3822	008	0	2016	Cook, DuPage, Kane and Will counties		2	1147	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	009	0	1	01	01	H3822_009_0	10		1	07/17/2015	2016.01	07/17/2015 05:23:47 PM Central Daylight Time	08/04/2015 07:56:34 AM Central Daylight Time	08/03/2015 02:29:16 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicaremt.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	009	0	2016	Missoula		2	6011	2			2							www.mybluemedicaremt.com	www.mybluemedicaremt.com	www.mybluemedicaremt.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	801	0	1	01	01	H3822_801_0	2		1	05/20/2015	2016.01	05/20/2015 04:53:13 PM Central Daylight Time	05/31/2015 02:15:06 PM Central Daylight Time				05/31/2015 03:55:14 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	801	0	2016	State of Illinois		1	5663	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H3822	802	0	1	01	01	H3822_802_0	2		1	05/20/2015	2016.01	05/29/2015 07:12:27 PM Central Daylight Time	05/31/2015 02:15:42 PM Central Daylight Time				05/31/2015 03:55:14 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicarenm.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	802	0	2016	State of New Mexico		1	5663	2			2							www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H3822	805	0	1	01	01	H3822_805_0	2		1	05/01/2015	2016.01	05/06/2015 08:29:56 AM Mountain Daylight Time	05/31/2015 02:16:18 PM Central Daylight Time				05/31/2015 03:55:14 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	805	0	2016	State of Illinois		1	5663	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H3822	806	0	1	01	01	H3822_806_0	2		1	05/01/2015	2016.01	05/06/2015 09:06:10 AM Mountain Daylight Time	05/31/2015 02:16:55 PM Central Daylight Time				05/31/2015 03:55:14 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicarenm.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	806	0	2016	State of New Mexico		1	5663	2			2							www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H3822	809	0	1	01	01	H3822_809_0	2		1	05/01/2015	2016.01	05/01/2015 10:41:00 AM Mountain Daylight Time	05/31/2015 04:03:14 PM Central Daylight Time				05/31/2015 04:20:57 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.getblueil.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	809	0	2016	State of Illinois		1	5663	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H3822	810	0	1	01	01	H3822_810_0	2		1	05/01/2015	2016.01	05/01/2015 11:04:25 AM Mountain Daylight Time	05/31/2015 04:03:49 PM Central Daylight Time				05/31/2015 04:20:57 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicarenm.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	810	0	2016	State of New Mexico		1	5663	2			2							www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H3822	813	0	1	01	01	H3822_813_0	4		1	05/20/2015	2016.01	05/20/2015 04:55:33 PM Central Daylight Time	05/31/2015 02:18:45 PM Central Daylight Time				05/31/2015 03:09:08 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicaremt.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H3822	813	0	2016	State of MT		1	5663	2			2							www.mybluemedicaremt.com	www.mybluemedicaremt.com	www.mybluemedicaremt.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	8a;11a;11b;	2		1					1	2			
H3822	814	0	1	01	01	H3822_814_0	4		1	05/20/2015	2016.01	05/20/2015 04:57:55 PM Central Daylight Time	05/31/2015 02:19:22 PM Central Daylight Time				05/31/2015 03:09:08 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicaremt.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H3822	814	0	2016	State of MT		1	5663	2			2							www.mybluemedicaremt.com	www.mybluemedicaremt.com	www.mybluemedicaremt.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	8a;11a;11b;	2		1					1	2			
H3822	815	0	1	01	01	H3822_815_0	5		1	05/20/2015	2016.01	05/20/2015 04:57:57 PM Central Daylight Time	05/31/2015 04:04:25 PM Central Daylight Time				05/31/2015 05:59:35 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, MT, NM	www.mybluemedicaremt.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H3822	815	0	2016	State of MT		1	5663	2			2							www.mybluemedicaremt.com	www.mybluemedicaremt.com	www.mybluemedicaremt.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	8a;11a;11b;	2		1					1	2			
H3832	007	0	1	04	01	H3832_007_0	9		1	07/24/2015	2016.01	07/24/2015 09:28:46 AM Hawaiian Standard Time	08/04/2015 05:16:59 AM Hawaiian Standard Time	07/29/2015 10:49:58 AM Hawaiian Standard Time			08/05/2015 03:27:29 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Standard (PPO)	01	04		1			H3832	007	0	2016	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)620-4672		(808)948-5555		(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	008	0	1	04	01	H3832_008_0	7		1	07/09/2015	2016.01	07/09/2015 04:23:23 PM Hawaiian Standard Time	08/04/2015 05:17:56 AM Hawaiian Standard Time	07/29/2015 10:51:04 AM Hawaiian Standard Time			08/04/2015 05:33:17 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Standard Plus (PPO)	01	04		1			H3832	008	0	2016	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)620-4672		(808)948-5555		(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	009	0	1	04	01	H3832_009_0	8		1	08/04/2015	2016.01	08/04/2015 04:41:28 PM Hawaiian Standard Time	08/05/2015 07:03:02 AM Hawaiian Standard Time	07/29/2015 10:53:33 AM Hawaiian Standard Time			08/05/2015 12:55:47 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Complete (PPO)	01	04		1			H3832	009	0	2016	Honolulu County		2		2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	010	0	1	04	01	H3832_010_0	8		1	08/04/2015	2016.01	08/04/2015 04:47:52 PM Hawaiian Standard Time	08/05/2015 07:03:38 AM Hawaiian Standard Time	07/29/2015 10:54:23 AM Hawaiian Standard Time			08/05/2015 01:01:48 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Complete Plus (PPO)	01	04		1			H3832	010	0	2016	County of Honolulu		2		2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	011	0	1	04	01	H3832_011_0	11	2	1	08/05/2015	2016.01	08/05/2015 03:19:24 PM Hawaiian Standard Time	08/05/2015 11:15:57 AM Hawaiian Standard Time	07/29/2015 10:54:44 AM Hawaiian Standard Time			08/05/2015 03:35:46 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Dual Care (PPO SNP)	01	04		1			H3832	011	0	2016	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)620-4672		(808)948-5555		(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	801	0	1	04	01	H3832_801_0	3		1	07/10/2015	2016.01	07/10/2015 06:16:33 PM Hawaiian Standard Time	05/31/2015 02:46:59 PM Hawaiian Standard Time				07/10/2015 06:41:52 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage EGWP with Drug CY (PPO)	01	04		1			H3832	801	0	2016	National		1	2000	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	802	0	1	04	01	H3832_802_0	3		1	06/01/2015	2016.01	06/01/2015 03:21:26 AM Hawaiian Standard Time	07/15/2015 06:25:53 AM Hawaiian Standard Time				07/15/2015 06:31:17 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage EGWP with Drug NCY (PPO)	01	04		1			H3832	802	0	2016	National		1	100	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	805	0	1	04	01	H3832_805_0	2		1	06/01/2015	2016.01	06/01/2015 03:20:57 AM Hawaiian Standard Time	05/31/2015 02:43:39 PM Hawaiian Standard Time				06/01/2015 03:32:23 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage EGWP CY (PPO)	01	04		1			H3832	805	0	2016	National		1	2000	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3832	807	0	1	04	01	H3832_807_0	3		1	06/01/2015	2016.01	06/01/2015 03:21:48 AM Hawaiian Standard Time	05/31/2015 12:39:40 PM Hawaiian Standard Time				06/01/2015 03:34:34 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Union Group Plan MAPD (PPO)	01	04		1			H3832	807	0	2016	National		1	5000	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3864	002	0	1	01	01	H3864_002_0	8		1	07/13/2015	2016.01	07/13/2015 12:09:56 PM Central Daylight Time	05/30/2015 07:22:58 PM Central Daylight Time				07/13/2015 03:55:23 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 2 (HMO)	01	01		1			H3864	002	0	2016	Central, Eastern Oregon and Mid-Columbia Gorge		2	1971	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	10		1	07/13/2015	2016.01	07/13/2015 09:45:15 AM Central Daylight Time	08/03/2015 11:12:44 AM Central Daylight Time	07/29/2015 05:41:16 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 6 (HMO)	01	01		1			H3864	006	0	2016	Central, Eastern Oregon and Mid-Columbia Gorge		2	3097	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	01	01	H3864_014_0	8		1	07/13/2015	2016.01	07/13/2015 09:45:20 AM Central Daylight Time	08/03/2015 11:13:44 AM Central Daylight Time	07/29/2015 05:41:06 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 14 (HMO)	01	01		1			H3864	014	0	2016	Central, Eastern Oregon and Mid-Columbia Gorge		2	4547	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	015	0	1	01	01	H3864_015_0	7		1	07/13/2015	2016.01	07/13/2015 09:47:22 AM Central Daylight Time	08/03/2015 11:14:44 AM Central Daylight Time	07/29/2015 05:40:53 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 15 (HMO)	01	01		1			H3864	015	0	2016	Lane County		2	2400	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	016	0	1	01	01	H3864_016_0	8		1	07/13/2015	2016.01	07/13/2015 09:54:50 AM Central Daylight Time	08/03/2015 11:15:42 AM Central Daylight Time	07/29/2015 05:40:42 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 16 (HMO)	01	01		1			H3864	016	0	2016	Southwestern Idaho		2	1704	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	019	0	1	01	01	H3864_019_0	8		1	07/13/2015	2016.01	07/13/2015 09:56:25 AM Central Daylight Time	08/03/2015 11:16:42 AM Central Daylight Time	07/29/2015 05:40:31 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 19 (HMO)	01	01		1			H3864	019	0	2016	Southwestern Oregon		2	190	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	020	0	1	01	01	H3864_020_0	8		1	07/13/2015	2016.01	07/13/2015 09:57:17 AM Central Daylight Time	08/03/2015 11:17:40 AM Central Daylight Time	07/29/2015 05:40:17 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 20 (HMO)	01	01		1			H3864	020	0	2016	Northern Idaho		2	1007	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	021	0	1	01	01	H3864_021_0	8		1	07/13/2015	2016.01	07/13/2015 09:58:49 AM Central Daylight Time	08/03/2015 11:18:40 AM Central Daylight Time	07/29/2015 05:40:04 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 21 (HMO)	01	01		1			H3864	021	0	2016	Eastern Idaho		2	470	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	022	0	1	01	01	H3864_022_0	9		1	07/13/2015	2016.01	07/13/2015 10:01:50 AM Central Daylight Time	08/03/2015 11:19:40 AM Central Daylight Time	07/29/2015 05:39:33 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 22 (HMO)	01	01		1			H3864	022	0	2016	Clackamas, Multnomah, and Washington Counties		2	500	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(503)894-7701		(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	023	0	1	01	01	H3864_023_0	9		1	07/13/2015	2016.01	07/13/2015 10:02:34 AM Central Daylight Time	08/03/2015 11:20:40 AM Central Daylight Time	07/29/2015 05:39:22 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 23 (HMO)	01	01		1			H3864	023	0	2016	Southwestern Idaho		2	400	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3864	024	0	1	02	01	H3864_024_0	10		1	07/16/2015	2016.01	07/16/2015 03:35:10 PM Central Daylight Time	08/03/2015 11:21:40 AM Central Daylight Time	07/29/2015 05:39:09 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Choice Rx 24 (HMO-POS)	01	02		1			H3864	024	0	2016	Southwestern Idaho		2	550	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	025	0	1	02	01	H3864_025_0	8		1	07/13/2015	2016.01	07/13/2015 10:06:16 AM Central Daylight Time	08/03/2015 11:22:40 AM Central Daylight Time	07/29/2015 05:38:58 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Choice Rx 25 (HMO-POS)	01	02		1			H3864	025	0	2016	Central, Eastern Oregon and Mid-Columbia Gorge		2	250	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	7		1	05/31/2015	2016.01	05/31/2015 12:04:34 PM Central Daylight Time	06/01/2015 04:04:40 PM Central Daylight Time				06/01/2015 06:22:24 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 801 (HMO)	01	01		1			H3864	801	0	2016	Statewide - Oregon and Idaho		1	1417	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;15;	2		1					1	2			
H3864	803	0	1	01	01	H3864_803_0	6		1	05/31/2015	2016.01	05/31/2015 12:05:23 PM Central Daylight Time	05/30/2015 07:36:06 PM Central Daylight Time				05/31/2015 02:17:59 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 803 (HMO)	01	01		1			H3864	803	0	2016	Statewide - Oregon and Idaho		1	100	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;15;	2		1					1	2			
H3890	001	0	1	04	01	H3890_001_0	10		1	08/10/2015	2016.01	08/10/2015 10:32:29 AM Central Daylight Time	08/04/2015 03:02:53 PM Central Daylight Time	08/04/2015 01:36:58 PM Central Daylight Time			08/10/2015 10:47:36 AM Central Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins	www.hopkinsmedicare.com	Johns Hopkins Advantage MD (PPO)	01	04		1			H3890	001	0	2016	Counties: AA BL BC CV CR HW MG SS WH WC WR		2	4625	2			2							www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com			(877)293-5325				(877)293-5325		(877)293-5325		(877)293-5325		(877)293-5325		(877)293-5325		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3890	002	0	1	04	01	H3890_002_0	11		1	08/10/2015	2016.01	08/10/2015 10:33:40 AM Central Daylight Time	08/04/2015 03:02:53 PM Central Daylight Time	08/04/2015 01:35:58 PM Central Daylight Time			08/10/2015 10:47:36 AM Central Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Plus (PPO)	01	04		1			H3890	002	0	2016	Counties: AA BL BC CV CR HW MG SS WH WC WR		2	1542	2			2							www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com			(877)293-5325				(877)293-5325		(877)293-5325		(877)293-5325		(877)293-5325		(877)293-5325		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3890	801	0	1	04	01	H3890_801_0	6		1	07/01/2015	2016.01	07/01/2015 04:58:34 PM Central Daylight Time	07/01/2015 03:30:01 PM Central Daylight Time				07/01/2015 06:18:40 PM Central Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan CY (PPO)	01	04		1			H3890	801	0	2016	Counties: AA BL BC CV CR HW MG SS WH WC WR		1	50	2			2							www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com			(877)293-5325				(877)293-5325		(877)293-5325		(877)293-5325		(877)293-5325		(877)293-5325		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;7b;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;	2		1						2			
H3890	802	0	1	04	01	H3890_802_0	6		1	07/01/2015	2016.01	07/01/2015 05:00:41 PM Central Daylight Time	07/01/2015 03:30:01 PM Central Daylight Time				07/01/2015 06:18:40 PM Central Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan Non-CY (PPO)	01	04		1			H3890	802	0	2016	Counties: AA BL BC CV CR HW MG SS WH WC WR		1	50	2			2							www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com			(877)293-5325				(877)293-5325		(877)293-5325		(877)293-5325		(877)293-5325		(877)293-5325		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;7b;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;	2		1						2			
H3890	803	0	1	04	01	H3890_803_0	6		1	07/01/2015	2016.01	07/01/2015 05:01:48 PM Central Daylight Time	07/01/2015 03:30:01 PM Central Daylight Time				07/01/2015 06:18:40 PM Central Daylight Time	HOPKINS HEALTH ADVANTAGE, INC.	Johns Hopkins	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan MA Only (PPO)	01	04		1			H3890	803	0	2016	Counties: AA BL BC CV CR HW MG SS WH WC WR		1	50	2			2							www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com			(877)293-5325				(877)293-5325										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;7b;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;	2		1						2			
H3907	002	0	1	01	01	H3907_002_0	5		1	05/14/2015	2016.01	05/14/2015 11:00:46 AM Eastern Daylight Time	07/17/2015 08:01:36 AM Eastern Daylight Time				07/17/2015 06:59:32 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life (HMO)	01	01		1			H3907	002	0	2016	Western Pennsylvania		2	18000	2			2							http://www.upmchealthplan.com/medicare	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										2					2					2	2			
H3907	006	0	1	01	01	H3907_006_0	10		1	07/07/2015	2016.01	07/07/2015 11:20:16 AM Eastern Daylight Time	08/05/2015 01:38:12 PM Eastern Daylight Time	07/29/2015 04:31:56 PM Eastern Daylight Time			08/05/2015 04:19:38 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx Enhanced (HMO)	01	01		1			H3907	006	0	2016	Western Pennsylvania		2	7000	2			2							http://www.upmchealthplan.com/medicare	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	029	0	1	01	01	H3907_029_0	7		1	06/01/2015	2016.01	06/01/2015 01:37:11 PM Eastern Daylight Time	08/05/2015 01:37:38 PM Eastern Daylight Time	07/29/2015 04:32:20 PM Eastern Daylight Time			08/05/2015 04:19:38 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx (HMO)	01	01		1			H3907	029	0	2016	Western Pennsylvania		2	40000	2			2							http://www.upmchealthplan.com/medicare	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	032	0	1	01	01	H3907_032_0	7		1	08/05/2015	2016.01	08/05/2015 02:42:00 PM Eastern Daylight Time	08/05/2015 01:38:50 PM Eastern Daylight Time	07/29/2015 04:32:48 PM Eastern Daylight Time			08/05/2015 04:19:38 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	www.upmchealthplan.com/snp	UPMC for Life Options (HMO SNP)	01	01		1			H3907	032	0	2016	Select PA Counties		2	300	2			1	1	3	1				www.upmchealthplan.com/snp	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		2					2					2	2			
H3907	037	0	1	01	01	H3907_037_0	7		1	06/01/2015	2016.01	06/01/2015 01:09:27 PM Eastern Daylight Time	08/05/2015 01:40:29 PM Eastern Daylight Time	07/29/2015 04:33:10 PM Eastern Daylight Time			08/05/2015 04:19:38 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Deductible with Rx (HMO)	01	01		1			H3907	037	0	2016	Western Pennsylvania		2	2000	2			2							http://www.upmchealthplan.com/medicare	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	038	0	1	01	01	H3907_038_0	5		1	05/14/2015	2016.01	05/14/2015 02:37:16 PM Eastern Daylight Time	07/17/2015 08:01:41 AM Eastern Daylight Time				07/17/2015 06:59:32 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO (HMO)	01	01		1			H3907	038	0	2016	Lancaster County		2	18000	2			2							http://www.upmchealthplan.com/medicare	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										2					2					2	2			
H3907	039	0	1	01	01	H3907_039_0	7		1	08/05/2015	2016.01	08/05/2015 10:15:03 AM Eastern Daylight Time	08/05/2015 01:41:10 PM Eastern Daylight Time	07/29/2015 04:33:34 PM Eastern Daylight Time			08/05/2015 04:19:38 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Deductible with Rx (HMO)	01	01		1			H3907	039	0	2016	Lancaster County		2	2000	2			2							http://www.upmchealthplan.com/medicare	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2	2			
H3907	801	0	1	01	01	H3907_801_0	4		1	05/19/2015	2016.01	05/19/2015 11:53:12 AM Eastern Daylight Time	06/01/2015 02:06:21 PM Eastern Daylight Time				06/01/2015 02:48:27 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC Employer Group (HMO)	01	01		1			H3907	801	0	2016	Western Pennsylvania		1		2			2							http://www.upmchealthplan.com/medicare	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										1	1	1a;1b;2;5;6;8b1;9a;11a;15;	2		1					1	2			
H3907	802	0	1	01	01	H3907_802_0	3		1	05/19/2015	2016.01	05/19/2015 01:30:49 PM Eastern Daylight Time	05/30/2015 01:47:17 PM Eastern Daylight Time				05/30/2015 04:57:02 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC Employer Group Rx (HMO)	01	01		1			H3907	802	0	2016	Western Pennsylvania		1		2			2							http://www.upmchealthplan.com/medicare	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	1a;1b;2;5;6;8b1;9a;9b;11a;15;	2		1					1	2			
H3907	803	0	1	01	01	H3907_803_0	4		1	05/19/2015	2016.01	05/19/2015 01:40:25 PM Eastern Daylight Time	07/13/2015 12:44:38 PM Eastern Daylight Time				07/13/2015 12:45:55 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare	UPMC Employer Group Rx (HMO)	01	01		1			H3907	803	0	2016	Western Pennsylvania		1		2			2							http://www.upmchealthplan.com/medicare	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	1a;1b;2;5;6;8b1;9a;9b;11a;15;	2		1					1	2			
H3908	001	0	1	20	08	H3908_001_0	3		1	05/18/2015	2016.01	05/18/2015 01:59:31 PM Eastern Daylight Time		05/15/2015 03:12:03 PM Eastern Daylight Time			05/18/2015 02:32:49 PM Eastern Daylight Time	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA	Trustees Of The University Of Pennsylvania	http://www.lifeupenn.org/	Trustees of the University of Pennsylvania (PACE)	08	20		1			H3908	001	0	2016	Philadelphia, PA		2		2			2								www.LIFEUPENN.org	www.CareKinesis.com									(215)573-7200		(215)573-7200		(215)573-7200		(215)573-7200										(215)573-7200		(215)573-7200		(215)573-7200		(215)573-7200																
H3908	002	0	1	20	08	H3908_002_0	4		1	05/22/2015	2016.01	05/22/2015 09:36:58 AM Eastern Daylight Time		05/15/2015 03:20:14 PM Eastern Daylight Time			05/22/2015 09:39:02 AM Eastern Daylight Time	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA	Trustees Of The University Of Pennsylvania	http://www.lifeupenn.org/	Trustees of the University of Pennsylvania (PACE)	08	20		1			H3908	002	0	2016	Philadelphia, PA		2		2			2								www.LIFEUPENN.org	www.CareKinesis.com									(215)573-7200		(215)573-7200		(215)573-7200		(215)573-7200										(215)573-7200		(215)573-7200		(215)573-7200		(215)573-7200																
H3909	001	0	1	04	01	H3909_001_0	4		1	05/29/2015	2016.01	05/29/2015 05:11:00 PM Eastern Daylight Time	08/04/2015 11:10:22 AM Eastern Daylight Time	08/04/2015 11:10:22 AM Eastern Daylight Time			08/04/2015 04:58:27 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	001	0	2016	Bucks, Philadelphia Counties		2	3647	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	1		1	05/29/2015	2016.01	05/29/2015 05:11:40 PM Eastern Daylight Time	05/29/2015 07:35:30 PM Eastern Daylight Time				05/29/2015 07:51:23 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Medical Only (PPO)	01	04		1			H3909	007	0	2016	Bucks, Philadelphia Counties		2	335	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	4		1	05/29/2015	2016.01	05/29/2015 05:12:23 PM Eastern Daylight Time	08/04/2015 11:10:22 AM Eastern Daylight Time	08/04/2015 11:10:22 AM Eastern Daylight Time			08/04/2015 05:04:08 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	009	0	2016	Chester, Delaware, Montgomery Counties		2	3634	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	2		1	05/29/2015	2016.01	05/29/2015 05:18:35 PM Eastern Daylight Time	05/30/2015 11:06:30 AM Eastern Daylight Time				05/30/2015 11:11:08 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Group Medical Only (PPO)	01	04		1			H3909	801	0	2016	National		1	484	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;	2		1						2			
H3909	802	0	1	04	01	H3909_802_0	2		1	05/29/2015	2016.01	05/29/2015 05:19:07 PM Eastern Daylight Time	05/30/2015 11:06:48 AM Eastern Daylight Time				05/30/2015 11:19:27 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Group Rx (PPO)	01	04		1			H3909	802	0	2016	National		1	1170	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;	2		1						2			
H3916	001	0	1	04	01	H3916_001_0	9		1	08/04/2015	2016.01	08/04/2015 07:59:58 AM Eastern Daylight Time	08/03/2015 10:32:34 AM Eastern Daylight Time	07/30/2015 08:06:53 AM Eastern Daylight Time			08/04/2015 08:24:25 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	001	0	2016	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H3916	002	0	1	04	01	H3916_002_0	8		1	08/04/2015	2016.01	08/04/2015 08:00:02 AM Eastern Daylight Time	08/03/2015 10:42:05 AM Eastern Daylight Time	07/30/2015 08:07:05 AM Eastern Daylight Time			08/04/2015 08:24:25 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	002	0	2016	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H3916	005	0	1	04	01	H3916_005_0	8		1	08/04/2015	2016.01	08/04/2015 08:00:10 AM Eastern Daylight Time	08/03/2015 10:33:31 AM Eastern Daylight Time	07/30/2015 08:07:21 AM Eastern Daylight Time			08/04/2015 08:24:25 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Deluxe (PPO)	01	04		1			H3916	005	0	2016	Central and Northeastern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H3916	012	0	1	04	01	H3916_012_0	6		1	07/10/2015	2016.01	07/10/2015 08:21:43 AM Eastern Daylight Time	05/28/2015 05:57:30 PM Eastern Daylight Time				07/10/2015 11:08:24 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Basic (PPO)	01	04		1			H3916	012	0	2016	Central and Northeastern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(800)227-8210		(800)227-8210										2					2						2			
H3916	015	0	1	04	01	H3916_015_0	9		1	08/04/2015	2016.01	08/04/2015 08:00:22 AM Eastern Daylight Time	08/03/2015 10:33:56 AM Eastern Daylight Time	07/30/2015 08:24:48 AM Eastern Daylight Time			08/04/2015 08:24:25 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Standard (PPO)	01	04		1			H3916	015	0	2016	Central and Northeastern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H3916	018	0	1	04	01	H3916_018_0	9		1	08/04/2015	2016.01	08/04/2015 08:00:30 AM Eastern Daylight Time	08/03/2015 10:34:21 AM Eastern Daylight Time	07/30/2015 08:25:03 AM Eastern Daylight Time			08/04/2015 08:24:25 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	018	0	2016	Central and Northeastern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H3916	022	0	1	04	01	H3916_022_0	9		1	08/04/2015	2016.01	08/04/2015 08:00:44 AM Eastern Daylight Time	08/03/2015 10:34:46 AM Eastern Daylight Time	07/30/2015 08:25:21 AM Eastern Daylight Time			08/04/2015 08:24:25 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Select (PPO)	01	04		1			H3916	022	0	2016	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H3916	024	0	1	04	01	H3916_024_0	9		1	08/04/2015	2016.01	08/04/2015 08:00:58 AM Eastern Daylight Time	08/03/2015 10:35:11 AM Eastern Daylight Time	07/30/2015 08:25:36 AM Eastern Daylight Time			08/04/2015 08:24:25 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO Select (PPO)	01	04		1			H3916	024	0	2016	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H3916	032	0	1	04	01	H3916_032_0	9		1	08/04/2015	2016.01	08/04/2015 08:01:07 AM Eastern Daylight Time	08/03/2015 10:35:36 AM Eastern Daylight Time	07/30/2015 08:25:56 AM Eastern Daylight Time			08/04/2015 08:24:25 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	032	0	2016	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H3916	033	0	1	04	01	H3916_033_0	9		1	08/04/2015	2016.01	08/04/2015 08:01:20 AM Eastern Daylight Time	08/03/2015 10:36:00 AM Eastern Daylight Time	07/30/2015 08:26:18 AM Eastern Daylight Time			08/04/2015 08:24:25 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	033	0	2016	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H3916	801	0	1	04	01	H3916_801_0	4		1	04/23/2015	2016.01	04/23/2015 08:52:43 AM Eastern Daylight Time	05/28/2015 06:00:28 PM Eastern Daylight Time				06/01/2015 10:59:51 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO MA PA CALENDAR (PPO)	01	04		1			H3916	801	0	2016	Pennsylvania		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(800)227-8210		(800)227-8210										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H3916	802	0	1	04	01	H3916_802_0	4		1	04/23/2015	2016.01	04/23/2015 08:54:04 AM Eastern Daylight Time	05/28/2015 06:01:00 PM Eastern Daylight Time				06/01/2015 10:59:51 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO MAPD PA CALENDAR (PPO)	01	04		1			H3916	802	0	2016	Pennsylvania		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H3916	804	0	1	04	01	H3916_804_0	4		1	04/23/2015	2016.01	04/23/2015 08:55:26 AM Eastern Daylight Time	05/28/2015 06:01:31 PM Eastern Daylight Time				06/01/2015 10:59:51 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Senior Health Company	www.highmarkblueshield.com/medicare	Freedom Blue PPO MAPD PA Non-Calendar (PPO)	01	04		1			H3916	804	0	2016	Pennsylvania		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H3917	001	0	1	20	08	H3917_001_0	2		1	08/11/2015	2016.01	08/11/2015 03:03:11 PM Eastern Daylight Time		08/07/2015 09:35:15 AM Eastern Daylight Time			08/11/2015 03:18:07 PM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Pittsburgh Care Partnership, Inc. (PACE)	08	20		1			H3917	001	0	2016	Allegheny, Westmoreland Counties (Partial of each)		2	543	2			2								www.commlife.org	www.commlife.org									(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101																
H3917	002	0	1	20	08	H3917_002_0	2		1	08/11/2015	2016.01	08/11/2015 03:03:21 PM Eastern Daylight Time		08/07/2015 09:45:12 AM Eastern Daylight Time			08/11/2015 03:18:07 PM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Pittsburgh Care Partnership, Inc. (PACE)	08	20		1			H3917	002	0	2016	Allegheny, Westmoreland Counties (Partial of each)		2	0	2			2								www.commlife.org	www.commlife.org									(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101																
H3918	001	0	1	20	08	H3918_001_0	1		1	05/21/2015	2016.01	05/21/2015 10:48:34 AM Eastern Daylight Time		05/18/2015 05:29:33 PM Eastern Daylight Time			05/21/2015 10:51:39 AM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Dual Eligibles Pharmacy (PACE)	08	20		1			H3918	001	0	2016	Partial Allegheny*		2		2			2								not applicable -- no formulary	none									(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228									(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228															
H3918	002	0	1	20	08	H3918_002_0	1		1	05/21/2015	2016.01	05/21/2015 10:48:53 AM Eastern Daylight Time		05/18/2015 05:30:37 PM Eastern Daylight Time			05/21/2015 10:51:39 AM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Medicare Only Pharmacy (PACE)	08	20		1			H3918	002	0	2016	Allegheny *		2		2			2								not applicable -- no formulary	none									(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228									(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228															
H3919	001	0	1	20	08	H3919_001_0	4		1	05/19/2015	2016.01	05/19/2015 04:05:38 PM Eastern Daylight Time		05/20/2015 02:43:47 PM Eastern Daylight Time			05/22/2015 03:16:01 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	www.mercylife.org	Mercy LIFE (PACE)	08	20		1			H3919	001	0	2016	Philadelphia & Delaware		2		2			2								www.mercylife.org	www.mercylife.org									(855)884-1037		(215)339-4747		(855)884-1037		(215)339-4747										(800)820-4512	4747	(215)339-4747		(800)820-4512	4747	(215)339-4747																
H3919	002	0	1	20	08	H3919_002_0	4		1	05/19/2015	2016.01	05/19/2015 04:06:22 PM Eastern Daylight Time		05/20/2015 02:48:40 PM Eastern Daylight Time			05/22/2015 03:16:01 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	www.mercylife.org	Mercy LIFE (PACE)	08	20		1			H3919	002	0	2016	Philadelphia & Delaware		2		2			2								www.mercylife.org	www.mercylife.org									(855)884-1037		(215)339-4747		(800)820-4512	4747	(215)339-4747										(800)820-4512	4747	(215)339-4747		(800)820-4512	4747	(215)339-4747																
H3923	013	0	1	04	01	H3923_013_0	8		1	07/14/2015	2016.01	07/14/2015 12:29:54 AM Eastern Daylight Time	07/30/2015 02:26:20 PM Eastern Daylight Time	07/30/2015 02:26:00 PM Eastern Daylight Time			07/31/2015 03:59:51 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	SeniorBlue - Option 2 (PPO)	01	04		1			H3923	013	0	2016	21 Counties in Central PA		2	8085	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	8		1	07/14/2015	2016.01	07/14/2015 12:27:56 AM Eastern Daylight Time	07/30/2015 02:25:50 PM Eastern Daylight Time	07/30/2015 02:25:28 PM Eastern Daylight Time			07/31/2015 03:59:51 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	SeniorBlue - Option 1 (PPO)	01	04		1			H3923	017	0	2016	21 Counties in Central PA		2	4340	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	4		1	05/31/2015	2016.01	05/31/2015 12:38:16 AM Eastern Daylight Time	06/01/2015 03:11:22 PM Eastern Daylight Time				06/01/2015 03:57:56 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	MA - ER with Rx (PPO)	01	04		1			H3923	801	0	2016	National		1	1764	2			2							www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	2		1						2			
H3923	802	0	1	04	01	H3923_802_0	3		1	05/31/2015	2016.01	05/31/2015 12:38:01 AM Eastern Daylight Time	06/01/2015 03:10:54 PM Eastern Daylight Time				06/01/2015 03:57:56 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	MA - ER w/o Rx (PPO)	01	04		1			H3923	802	0	2016	National		1	70	2			2							www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	2		1						2			
H3923	803	0	1	04	01	H3923_803_0	3		1	05/31/2015	2016.01	05/31/2015 12:41:23 AM Eastern Daylight Time	06/01/2015 03:08:22 PM Eastern Daylight Time				06/01/2015 03:57:56 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	MA - ER Non-Calendar w Rx (PPO)	01	04		1			H3923	803	0	2016	National		1	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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	2		1						2			
H3924	059	3	1	04	01	H3924_059_3	6		1	08/04/2015	2016.01	08/04/2015 04:23:03 PM Eastern Daylight Time	08/04/2015 12:19:44 PM Eastern Daylight Time	08/04/2015 12:19:46 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	3	2016	Pennsylvania	South - 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	059	4	1	04	01	H3924_059_4	6		1	07/08/2015	2016.01	07/08/2015 08:50:09 PM Eastern Daylight Time	08/04/2015 12:19:46 PM Eastern Daylight Time	08/04/2015 12:19:46 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	4	2016	Pennsylvania	Southeast - 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	059	6	1	04	01	H3924_059_6	6		1	07/08/2015	2016.01	07/08/2015 08:50:23 PM Eastern Daylight Time	08/04/2015 12:19:46 PM Eastern Daylight Time	08/04/2015 12:19:46 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	6	2016	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			
H3924	059	7	1	04	01	H3924_059_7	6		1	07/08/2015	2016.01	07/08/2015 08:50:41 PM Eastern Daylight Time	08/04/2015 12:19:46 PM Eastern Daylight Time	08/04/2015 12:19:46 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	7	2016	Pennsylvania	Northeast - 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	059	8	1	04	01	H3924_059_8	6		1	07/08/2015	2016.01	07/18/2015 03:12:56 PM Eastern Daylight Time	08/04/2015 12:19:46 PM Eastern Daylight Time	08/04/2015 12:19:46 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	8	2016	Pennsylvania	West - 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	059	9	1	04	01	H3924_059_9	6		1	07/08/2015	2016.01	07/08/2015 08:53:02 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	9	2016	Pennsylvania	Southwest - 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	060	3	1	04	01	H3924_060_3	6		1	08/04/2015	2016.01	08/04/2015 12:57:31 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	3	2016	Pennsylvania	South - 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	060	4	1	04	01	H3924_060_4	6		1	08/04/2015	2016.01	08/04/2015 12:57:52 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	4	2016	Pennsylvania	Southeast - 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	060	6	1	04	01	H3924_060_6	6		1	08/04/2015	2016.01	08/04/2015 12:58:15 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	6	2016	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			
H3924	060	7	1	04	01	H3924_060_7	6		1	08/04/2015	2016.01	08/04/2015 12:58:37 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	7	2016	Pennsylvania	Northeast - 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	060	8	1	04	01	H3924_060_8	6		1	08/04/2015	2016.01	08/04/2015 12:58:57 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	8	2016	Pennsylvania	West - 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	060	9	1	04	01	H3924_060_9	6		1	08/04/2015	2016.01	08/04/2015 12:59:25 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	9	2016	Pennsylvania	Southwest - 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			
H3925	001	0	1	20	08	H3925_001_0	1		1	05/20/2015	2016.01	05/20/2015 10:28:43 AM Eastern Daylight Time		05/18/2015 02:43:43 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown	www.seniorlifejohnstown.com	Senior LIFE Johnstown Dual Eligible (PACE)	08	20		1			H3925	001	0	2016	Senior LIFE Cambria Somerset County Dual		2	200	2			2								NA	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3925	002	0	1	20	08	H3925_002_0	1		1	05/20/2015	2016.01	05/20/2015 10:28:55 AM Eastern Daylight Time		05/18/2015 02:43:43 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown	www.seniorlifejohnstown.com	Senior LIFE Johnstown MC Only (PACE)	08	20		1			H3925	002	0	2016	Senior LIFE Cambria Somerset County MC Only		2	1	2			2								NA	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3928	001	0	1	01	01	H3928_001_0	5		1	07/31/2015	2016.01	07/31/2015 11:16:28 AM Eastern Daylight Time	07/31/2015 10:41:30 AM Eastern Daylight Time	07/29/2015 05:15:54 PM Eastern Daylight Time			08/01/2015 05:48:36 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF LOUISIANA, INC.	Coventry Health Care	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	001	0	2016	New Orleans/Baton Rouge Metro Parishes		2	100	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://LAformulary.coventry-medicare.com	http://www.PharmacyLocator.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)338-9551		(855)338-9551		(866)295-1824		(866)295-1824		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3928	002	0	1	01	01	H3928_002_0	5		1	07/31/2015	2016.01	07/31/2015 11:20:35 AM Eastern Daylight Time	07/31/2015 03:53:08 PM Eastern Daylight Time	07/29/2015 05:16:13 PM Eastern Daylight Time			08/01/2015 05:48:36 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF LOUISIANA, INC.	Coventry Health Care	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	002	0	2016	Caddo, Bossier and St. Tammany		2	100	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://LAformulary.coventry-medicare.com	http://www.PharmacyLocator.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)338-9551		(855)338-9551		(866)295-1824		(866)295-1824		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3928	801	0	1	01	01	H3928_801_0	2		1	07/17/2015	2016.01	07/17/2015 11:08:26 AM Eastern Daylight Time	07/17/2015 10:25:37 AM Eastern Daylight Time				07/17/2015 11:22:27 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF LOUISIANA, INC.	Coventry Health Care	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	801	0	2016	Louisiana - Employer Group Plan CYD with RX		1	100	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://www.LAformulary.coventry-medicare.com	http://www.PharmacyLocator.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)338-9551		(855)338-9551		(866)295-1824		(866)295-1824		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1					1	2			
H3928	803	0	1	01	01	H3928_803_0	2		1	07/17/2015	2016.01	07/17/2015 11:09:39 AM Eastern Daylight Time	07/17/2015 10:25:27 AM Eastern Daylight Time				07/17/2015 11:22:27 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF LOUISIANA, INC.	Coventry Health Care	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	803	0	2016	Louisiana Employer Group CYD No RX		1	100	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://LAformulary.coventry-medicare.com	http://www.PharmacyLocator.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1					1	2			
H3931	004	0	1	01	01	H3931_004_0	7		1	07/07/2015	2016.01	07/07/2015 11:49:24 AM Eastern Daylight Time	08/02/2015 11:03:10 AM Eastern Daylight Time	07/29/2015 05:16:32 PM Eastern Daylight Time			08/03/2015 10:58:13 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H3931	004	0	2016	Bucks, Chester and Delaware Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	055	0	1	01	01	H3931_055_0	3		1	07/16/2015	2016.01	07/16/2015 01:40:11 PM Eastern Daylight Time	07/14/2015 04:52:28 PM Eastern Daylight Time				07/16/2015 05:55:52 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basic Plan (HMO)	01	01		1			H3931	055	0	2016	Bucks County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3931	064	0	1	01	01	H3931_064_0	4		1	07/31/2015	2016.01	07/31/2015 09:26:22 PM Eastern Daylight Time	08/02/2015 11:03:47 AM Eastern Daylight Time	07/29/2015 05:16:51 PM Eastern Daylight Time			08/03/2015 10:58:13 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	064	0	2016	Bucks, Chester and Delaware Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	065	0	1	01	01	H3931_065_0	4		1	07/16/2015	2016.01	07/16/2015 01:41:17 PM Eastern Daylight Time	08/02/2015 11:04:27 AM Eastern Daylight Time	07/29/2015 05:17:10 PM Eastern Daylight Time			08/03/2015 10:58:13 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	065	0	2016	Philadelphia County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	070	0	1	01	01	H3931_070_0	5		1	08/01/2015	2016.01	08/01/2015 10:21:29 PM Eastern Daylight Time	08/02/2015 09:07:52 PM Eastern Daylight Time	07/29/2015 05:17:29 PM Eastern Daylight Time			08/03/2015 10:58:13 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	070	0	2016	Central and NE PA		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	081	0	1	01	01	H3931_081_0	7		1	07/31/2015	2016.01	07/31/2015 09:55:13 PM Eastern Daylight Time	07/31/2015 04:51:38 PM Eastern Daylight Time	07/29/2015 05:17:48 PM Eastern Daylight Time			08/01/2015 05:05:37 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	081	0	2016	Raleigh and Surrounding Area		2	31500	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	083	0	1	01	01	H3931_083_0	5		1	07/16/2015	2016.01	07/16/2015 03:57:46 PM Eastern Daylight Time	08/02/2015 11:05:50 AM Eastern Daylight Time	07/29/2015 05:18:07 PM Eastern Daylight Time			08/03/2015 10:58:13 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	083	0	2016	Montgomery County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	084	0	1	01	01	H3931_084_0	6		1	07/16/2015	2016.01	07/16/2015 05:53:20 PM Eastern Daylight Time	08/02/2015 11:06:29 AM Eastern Daylight Time	07/29/2015 05:18:26 PM Eastern Daylight Time			08/03/2015 10:58:13 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H3931	084	0	2016	Montgomery County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	087	0	1	01	01	H3931_087_0	5		1	07/31/2015	2016.01	07/31/2015 09:56:21 PM Eastern Daylight Time	07/31/2015 04:52:57 PM Eastern Daylight Time	07/29/2015 05:18:45 PM Eastern Daylight Time			08/01/2015 05:05:37 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	087	0	2016	Raleigh and Surrounding area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	088	0	1	01	01	H3931_088_0	6		1	07/24/2015	2016.01	07/24/2015 12:02:42 PM Eastern Daylight Time	08/02/2015 07:03:58 PM Eastern Daylight Time	07/29/2015 05:19:04 PM Eastern Daylight Time			08/03/2015 08:43:54 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Connect Plus (HMO)	01	01		1			H3931	088	0	2016	North Carolina and Kentucky		2	28	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	090	0	1	01	01	H3931_090_0	4		1	07/31/2015	2016.01	07/31/2015 11:01:23 PM Eastern Daylight Time	08/02/2015 08:50:36 PM Eastern Daylight Time	07/29/2015 05:19:23 PM Eastern Daylight Time			08/03/2015 01:29:55 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	090	0	2016	Boone, Campbell and Kenton counties		2	35	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	091	0	1	01	01	H3931_091_0	7		1	08/05/2015	2016.01	08/05/2015 04:30:48 PM Eastern Daylight Time	08/04/2015 04:22:53 PM Eastern Daylight Time	07/29/2015 05:19:42 PM Eastern Daylight Time			08/05/2015 04:50:29 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PinnacleHealth Prime Plan (HMO)	01	01		1			H3931	091	0	2016	Cumberland and Dauphin counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	092	0	1	01	01	H3931_092_0	9		1	07/31/2015	2016.01	07/31/2015 09:58:08 PM Pacific Daylight Time	08/03/2015 09:02:01 AM Eastern Daylight Time	07/29/2015 05:20:01 PM Eastern Daylight Time			08/03/2015 10:33:04 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	092	0	2016	Maricopa County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	093	0	1	01	01	H3931_093_0	9		1	07/31/2015	2016.01	07/31/2015 09:58:36 PM Pacific Daylight Time	08/03/2015 09:03:15 AM Eastern Daylight Time	07/29/2015 05:20:20 PM Eastern Daylight Time			08/03/2015 10:33:04 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	093	0	2016	Denver and Surrounding Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	094	0	1	01	01	H3931_094_0	7		1	07/31/2015	2016.01	07/31/2015 10:00:45 PM Pacific Daylight Time	08/02/2015 07:13:21 PM Eastern Daylight Time	07/29/2015 05:20:39 PM Eastern Daylight Time			08/03/2015 09:37:59 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	094	0	2016	Clark County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	095	0	1	01	01	H3931_095_0	4		1	07/31/2015	2016.01	07/31/2015 08:49:47 PM Eastern Daylight Time	07/31/2015 07:20:56 PM Eastern Daylight Time	07/29/2015 05:20:58 PM Eastern Daylight Time			07/31/2015 09:17:25 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	095	0	2016	District of Columbia		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	096	0	1	01	01	H3931_096_0	4		1	07/31/2015	2016.01	07/31/2015 06:28:54 PM Eastern Daylight Time	07/31/2015 07:18:40 PM Eastern Daylight Time	07/29/2015 05:21:17 PM Eastern Daylight Time			07/31/2015 09:17:25 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Innovation Prime Plan (HMO)	01	01		1			H3931	096	0	2016	Fairfax County and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	097	0	1	01	01	H3931_097_0	5		1	07/15/2015	2016.01	07/15/2015 12:19:03 PM Eastern Daylight Time	07/30/2015 02:28:09 PM Eastern Daylight Time	07/29/2015 05:21:36 PM Eastern Daylight Time			07/31/2015 09:17:25 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Connect Plus (HMO)	01	01		1			H3931	097	0	2016	Southern Maryland		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	098	0	1	01	01	H3931_098_0	5		1	07/31/2015	2016.01	07/31/2015 06:29:54 PM Eastern Daylight Time	07/31/2015 07:16:31 PM Eastern Daylight Time	07/29/2015 05:21:55 PM Eastern Daylight Time			07/31/2015 09:17:25 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	098	0	2016	Richmond and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	099	0	1	01	01	H3931_099_0	5		1	07/31/2015	2016.01	07/31/2015 06:30:55 PM Eastern Daylight Time	07/31/2015 07:12:03 PM Eastern Daylight Time	07/29/2015 05:22:15 PM Eastern Daylight Time			07/31/2015 09:17:25 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	099	0	2016	Danville and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	100	0	1	01	01	H3931_100_0	6		1	07/31/2015	2016.01	07/31/2015 06:34:40 PM Eastern Daylight Time	07/31/2015 07:08:47 PM Eastern Daylight Time	07/29/2015 05:22:34 PM Eastern Daylight Time			07/31/2015 09:17:25 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	100	0	2016	Newport News and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	101	0	1	01	01	H3931_101_0	4		1	07/31/2015	2016.01	07/31/2015 06:35:31 PM Eastern Daylight Time	07/31/2015 07:06:22 PM Eastern Daylight Time	07/29/2015 05:22:53 PM Eastern Daylight Time			07/31/2015 09:17:25 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	101	0	2016	Roanoke and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	102	0	1	01	01	H3931_102_0	5		1	07/31/2015	2016.01	07/31/2015 09:33:29 PM Eastern Daylight Time	08/03/2015 10:35:23 AM Eastern Daylight Time	07/29/2015 05:23:12 PM Eastern Daylight Time			08/03/2015 10:58:13 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	102	0	2016	New Castle and Kent Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	104	0	1	01	01	H3931_104_0	6		1	07/31/2015	2016.01	07/31/2015 09:34:17 PM Eastern Daylight Time	08/03/2015 10:35:23 AM Eastern Daylight Time	07/29/2015 05:23:32 PM Eastern Daylight Time			08/03/2015 10:58:13 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (HMO)	01	01		1			H3931	104	0	2016	New Castle and Kent Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	105	0	1	01	01	H3931_105_0	7		1	08/05/2015	2016.01	08/05/2015 04:34:57 PM Eastern Daylight Time	08/04/2015 04:24:29 PM Eastern Daylight Time	07/29/2015 05:23:51 PM Eastern Daylight Time			08/05/2015 04:50:29 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Main Line Health Prime Plan (HMO)	01	01		1			H3931	105	0	2016	Chester, Delaware and Montgomery counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	106	0	1	01	01	H3931_106_0	5		1	07/31/2015	2016.01	07/31/2015 09:57:52 PM Eastern Daylight Time	07/31/2015 07:51:00 PM Eastern Daylight Time	07/29/2015 05:24:10 PM Eastern Daylight Time			08/01/2015 11:48:44 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	106	0	2016	Cook County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	107	0	1	01	01	H3931_107_0	6		1	07/31/2015	2016.01	07/31/2015 11:02:59 PM Eastern Daylight Time	08/03/2015 10:40:37 AM Eastern Daylight Time	07/29/2015 05:24:29 PM Eastern Daylight Time			08/03/2015 12:13:45 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	107	0	2016	Cleveland and NE OH Area		2	8673	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	108	0	1	01	01	H3931_108_0	4		1	07/31/2015	2016.01	07/31/2015 11:03:04 PM Eastern Daylight Time	08/03/2015 01:44:49 PM Eastern Daylight Time	07/29/2015 05:24:48 PM Eastern Daylight Time			08/03/2015 02:41:56 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	108	0	2016	Columbus OH Area		2	2579	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	109	0	1	01	01	H3931_109_0	5		1	08/10/2015	2016.01	08/10/2015 11:37:59 AM Eastern Daylight Time	08/03/2015 10:43:25 AM Eastern Daylight Time	07/29/2015 05:25:08 PM Eastern Daylight Time			08/10/2015 12:42:58 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	109	0	2016	Toledo and Cincinnati Area		2	4827	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	110	0	1	01	01	H3931_110_0	4		1	08/04/2015	2016.01	08/04/2015 06:09:59 PM Eastern Daylight Time	08/05/2015 11:10:52 AM Eastern Daylight Time	08/05/2015 01:46:43 PM Eastern Daylight Time			08/05/2015 02:22:29 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	110	0	2016	Dayton		2	436	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	111	0	1	01	01	H3931_111_0	9		1	07/21/2015	2016.01	07/21/2015 09:57:10 AM Eastern Daylight Time	08/02/2015 07:06:55 PM Eastern Daylight Time	07/29/2015 05:25:46 PM Eastern Daylight Time			08/03/2015 08:43:54 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Connect Plus (HMO)	01	01		1			H3931	111	0	2016	Richmond, Danville and Tidewater Virginia		2	0	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	801	0	1	01	01	H3931_801_0	2		1	05/29/2015	2016.01	05/29/2015 12:13:03 PM Eastern Daylight Time	07/16/2015 05:26:24 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3931	801	0	2016	Pennsylvania		1	2230	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1	2			
H3931	804	0	1	01	01	H3931_804_0	2		1	05/29/2015	2016.01	05/29/2015 12:13:21 PM Eastern Daylight Time	07/16/2015 05:26:24 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3931	804	0	2016	Pennsylvania		1	6995	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H3942	001	0	1	20	08	H3942_001_0	1		1	05/27/2015	2016.01	05/27/2015 09:00:23 AM Eastern Daylight Time		05/26/2015 11:00:25 AM Eastern Daylight Time			05/27/2015 09:11:57 AM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	001	0	2016	Elderhaus PACE		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	05/27/2015	2016.01	05/27/2015 09:00:45 AM Eastern Daylight Time		05/26/2015 12:11:03 PM Eastern Daylight Time			05/27/2015 09:11:57 AM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	http://www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	002	0	2016	Elderhaus PACE		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																
H3945	002	0	1	01	01	H3945_002_0	5		1	07/14/2015	2016.01	07/14/2015 04:31:40 PM Central Daylight Time	08/01/2015 09:42:07 AM Central Daylight Time	07/30/2015 08:18:12 AM Central Daylight Time			08/03/2015 09:09:24 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	01	01		1			H3945	002	0	2016	Lake, Indiana		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3945	003	0	1	02	01	H3945_003_0	4		1	08/03/2015	2016.01	08/03/2015 11:45:17 AM Central Daylight Time	08/03/2015 03:40:10 PM Central Daylight Time	07/30/2015 08:18:41 AM Central Daylight Time			08/03/2015 09:09:24 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H3945	003	0	2016	Lake, Indiana		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3945	801	0	1	01	01	H3945_801_0	3		1	05/21/2015	2016.01	05/21/2015 09:12:37 PM Central Daylight Time	07/12/2015 09:31:31 AM Central Daylight Time				07/16/2015 01:03:39 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H3945	801	0	2016	Statewide IN		1		2			2							wwww.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H3945	802	0	1	02	01	H3945_802_0	3		1	05/21/2015	2016.01	05/21/2015 09:15:16 PM Central Daylight Time	07/12/2015 09:32:02 AM Central Daylight Time				07/16/2015 01:03:39 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H3945	802	0	2016	Statewide IN		1		2			2							wwww.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H3945	803	0	1	01	01	H3945_803_0	2		1	05/21/2015	2016.01	05/21/2015 09:15:43 PM Central Daylight Time	07/12/2015 09:32:31 AM Central Daylight Time				07/16/2015 01:03:39 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H3945	803	0	2016	Statewide IN		1		2			2							wwww.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H3945	804	0	1	02	01	H3945_804_0	3		1	05/21/2015	2016.01	05/21/2015 09:15:56 PM Central Daylight Time	07/12/2015 09:33:00 AM Central Daylight Time				07/16/2015 01:03:39 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H3945	804	0	2016	Statewide IN		1		2			2							wwww.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H3945	805	0	1	01	01	H3945_805_0	3		1	05/21/2015	2016.01	05/21/2015 09:16:08 PM Central Daylight Time	07/12/2015 09:33:30 AM Central Daylight Time				07/16/2015 01:03:39 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H3945	805	0	2016	Statewide IN		1		2			2							wwww.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H3945	806	0	1	02	01	H3945_806_0	3		1	05/21/2015	2016.01	05/21/2015 09:16:22 PM Central Daylight Time	07/12/2015 09:34:00 AM Central Daylight Time				07/16/2015 01:03:39 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H3945	806	0	2016	Statewide IN		1		2			2							wwww.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H3949	009	0	1	01	01	H3949_009_0	4	2	1	07/15/2015	2016.01	07/15/2015 08:39:10 AM Central Daylight Time	07/31/2015 01:51:59 PM Central Daylight Time	07/30/2015 08:19:14 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H3949	009	0	2016	Select Pennsylvania Counties		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	013	0	1	01	01	H3949_013_0	5		1	07/14/2015	2016.01	07/14/2015 04:21:53 PM Central Daylight Time	07/31/2015 07:33:38 PM Central Daylight Time	07/30/2015 08:19:44 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Plus (HMO)	01	01		1			H3949	013	0	2016	Philadelphia Metro Areas		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	016	0	1	01	01	H3949_016_0	4		1	07/14/2015	2016.01	07/14/2015 04:22:11 PM Central Daylight Time	07/31/2015 01:52:42 PM Central Daylight Time	07/30/2015 08:20:16 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Traditions (HMO SNP)	01	01		1			H3949	016	0	2016	Select Pennsylvania Counties		2		2			1	1	1	1				www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	024	0	1	01	01	H3949_024_0	4		1	07/14/2015	2016.01	07/14/2015 04:22:32 PM Central Daylight Time	07/31/2015 01:53:11 PM Central Daylight Time	07/30/2015 08:20:45 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Achieve (HMO SNP)	01	01		1			H3949	024	0	2016	Select Pennsylvania Counties		2		2			1	4		1		00000010000000000000		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	026	0	1	01	01	H3949_026_0	3		1	07/14/2015	2016.01	07/14/2015 04:22:51 PM Central Daylight Time	07/12/2015 09:36:26 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H3949	026	0	2016	Select Pennsylvania Counties		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3949	027	0	1	02	01	H3949_027_0	5		1	07/14/2015	2016.01	07/14/2015 04:23:22 PM Central Daylight Time	07/31/2015 01:53:41 PM Central Daylight Time	07/30/2015 08:21:15 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H3949	027	0	2016	Philadelphia, Montgomery, Bucks & Lehigh Valley		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	028	0	1	01	01	H3949_028_0	5		1	07/14/2015	2016.01	07/14/2015 04:23:36 PM Central Daylight Time	07/31/2015 01:54:11 PM Central Daylight Time	07/30/2015 08:21:44 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreventiveCare (HMO)	01	01		1			H3949	028	0	2016	Select Pennsylvania Counties		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	030	0	1	01	01	H3949_030_0	4		1	07/14/2015	2016.01	07/14/2015 04:23:52 PM Central Daylight Time	07/31/2015 01:54:40 PM Central Daylight Time	07/30/2015 08:22:13 AM Central Daylight Time			08/03/2015 04:19:48 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H3949	030	0	2016	Pennsylvania		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3949	804	0	1	01	01	H3949_804_0	4		1	05/08/2015	2016.01	05/08/2015 06:46:12 PM Eastern Daylight Time	07/12/2015 09:38:23 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H3949	804	0	2016	Statewide PA		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;12;	1					1	2			
H3949	806	0	1	02	01	H3949_806_0	5		1	05/28/2015	2016.01	05/28/2015 12:06:10 PM Eastern Daylight Time	07/12/2015 09:38:52 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H3949	806	0	2016	Statewide PA		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;12;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7d;12;	1	2			
H3949	807	0	1	01	01	H3949_807_0	4		1	05/08/2015	2016.01	05/08/2015 06:45:38 PM Eastern Daylight Time	07/12/2015 09:39:21 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H3949	807	0	2016	Statewide PA		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;12;	1					1	2			
H3949	808	0	1	01	01	H3949_808_0	4		1	05/08/2015	2016.01	05/08/2015 06:45:58 PM Eastern Daylight Time	07/12/2015 09:39:50 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H3949	808	0	2016	Statewide PA		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;12;	1					1	2			
H3949	809	0	1	02	01	H3949_809_0	5		1	05/28/2015	2016.01	05/28/2015 11:36:39 AM Eastern Daylight Time	07/12/2015 09:40:19 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H3949	809	0	2016	Statewide PA		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;12;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7d;12;	1	2			
H3949	810	0	1	02	01	H3949_810_0	5		1	05/28/2015	2016.01	05/28/2015 11:36:53 AM Eastern Daylight Time	07/12/2015 09:40:48 AM Central Daylight Time				07/16/2015 01:11:12 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H3949	810	0	2016	Statewide PA		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7f;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7d;12;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7d;12;	1	2			
H3952	008	0	1	01	01	H3952_008_0	2		1	05/27/2015	2016.01	05/27/2015 10:08:56 AM Eastern Daylight Time	05/29/2015 05:24:18 PM Eastern Daylight Time				05/29/2015 05:31:36 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	01	01		1			H3952	008	0	2016	Bucks, Philadelphia Counties		2	3063	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	05/27/2015	2016.01	05/27/2015 10:09:07 AM Eastern Daylight Time	08/04/2015 11:10:23 AM Eastern Daylight Time	08/04/2015 11:10:23 AM Eastern Daylight Time			08/04/2015 05:11:04 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	01	01		1			H3952	020	0	2016	Bucks, Philadelphia Counties		2	11040	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	1		1	05/27/2015	2016.01	05/27/2015 10:09:27 AM Eastern Daylight Time	05/29/2015 05:25:25 PM Eastern Daylight Time				05/29/2015 05:47:11 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	01	01		1			H3952	044	0	2016	Chester, Delaware, Montgomery Counties		2	1626	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	05/27/2015	2016.01	05/27/2015 10:09:45 AM Eastern Daylight Time	08/04/2015 11:10:23 AM Eastern Daylight Time	08/04/2015 11:10:23 AM Eastern Daylight Time			08/04/2015 05:18:15 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	01	01		1			H3952	045	0	2016	Chester, Delaware, Montgomery Counties		2	6542	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3952	048	0	1	01	01	H3952_048_0	1		1	05/27/2015	2016.01	05/27/2015 10:10:01 AM Eastern Daylight Time	05/29/2015 05:25:51 PM Eastern Daylight Time				05/29/2015 05:51:59 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	01	01		1			H3952	048	0	2016	Bucks, Philadelphia Counties		2	3198	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	05/27/2015	2016.01	05/27/2015 10:10:20 AM Eastern Daylight Time	08/04/2015 11:10:23 AM Eastern Daylight Time	08/04/2015 11:10:24 AM Eastern Daylight Time			08/04/2015 05:23:52 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	01	01		1			H3952	049	0	2016	Bucks, Philadelphia Counties		2	24484	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	1		1	05/27/2015	2016.01	05/27/2015 10:10:37 AM Eastern Daylight Time	05/29/2015 05:26:24 PM Eastern Daylight Time				05/29/2015 05:57:09 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	01	01		1			H3952	050	0	2016	Chester, Deleware, Montgomery Counties		2	3489	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	4		1	05/27/2015	2016.01	05/27/2015 10:11:04 AM Eastern Daylight Time	08/04/2015 11:10:24 AM Eastern Daylight Time	08/04/2015 11:10:24 AM Eastern Daylight Time			08/04/2015 05:28:28 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	01	01		1			H3952	051	0	2016	Chester, Delaware, Montgomery Counties		2	19081	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	01	01	H3952_053_0	5		1	07/30/2015	2016.01	07/30/2015 04:05:40 PM Eastern Daylight Time	08/04/2015 11:10:24 AM Eastern Daylight Time	08/04/2015 11:10:24 AM Eastern Daylight Time			08/04/2015 05:34:37 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Focus Rx (HMO)	01	01		1			H3952	053	0	2016	Philadelphia, Bucks		2	5942	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	01	01	H3952_054_0	5		1	07/30/2015	2016.01	07/30/2015 04:06:35 PM Eastern Daylight Time	08/04/2015 11:10:25 AM Eastern Daylight Time	08/04/2015 11:10:20 AM Eastern Daylight Time			08/04/2015 05:43:20 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Focus Rx (HMO)	01	01		1			H3952	054	0	2016	Chester, Delaware, Montgomery		2	3200	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3952	802	0	1	01	01	H3952_802_0	1		1	05/27/2015	2016.01	05/27/2015 12:28:25 PM Eastern Daylight Time	05/29/2015 05:27:24 PM Eastern Daylight Time				05/29/2015 06:19:22 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Group Medical Only (HMO)	01	01		1			H3952	802	0	2016	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	1589	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;	1	7b;7c;7d;7f;7g;7i;8b1;8b2;8b3;16b;18a;	1					1	2			
H3952	804	0	1	01	01	H3952_804_0	1		1	05/27/2015	2016.01	05/27/2015 10:20:44 AM Eastern Daylight Time	05/29/2015 05:27:33 PM Eastern Daylight Time				05/29/2015 06:21:47 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Group Rx (HMO)	01	01		1			H3952	804	0	2016	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	3724	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;8b1;8b2;8b3;9a;9b;10a;11a;11b;11c;15;	1	7b;7c;7d;7f;7g;7i;8b1;8b2;8b3;16b;18a;	1					1	2			
H3954	097	0	1	01	01	H3954_097_0	7	2	1	08/04/2015	2016.01	08/04/2015 02:03:27 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time	08/04/2015 12:19:47 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Secure Rx (HMO SNP)	01	01		1			H3954	097	0	2016	Pennsylvania		2		2			1	3		1	3		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	146	0	1	01	01	H3954_146_0	6		1	07/08/2015	2016.01	07/08/2015 09:52:09 PM Eastern Daylight Time	08/04/2015 12:19:31 PM Eastern Daylight Time	08/04/2015 12:19:31 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Classic Rx (HMO)	01	01		1			H3954	146	0	2016	Monmouth and Ocean Counties, New Jersey		2		2			2							www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376		(800)988-4861		(570)271-5673		(800)419-1376		(800)419-1376		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	156	1	1	01	01	H3954_156_1	5		1	07/08/2015	2016.01	07/08/2015 09:55:10 PM Eastern Daylight Time	07/17/2015 08:00:00 AM Eastern Daylight Time				07/20/2015 10:47:36 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	1	2016	Pennsylvania	Central - Pennsylvania	2	1000	2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	2	1	01	01	H3954_156_2	5		1	07/08/2015	2016.01	07/08/2015 09:57:38 PM Eastern Daylight Time	07/17/2015 08:00:00 AM Eastern Daylight Time				07/20/2015 10:47:36 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	2	2016	Pennsylvania	Northeast - Pennsylvania	2	1000	2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	3	1	01	01	H3954_156_3	5		1	07/08/2015	2016.01	07/08/2015 09:57:47 PM Eastern Daylight Time	07/17/2015 08:00:01 AM Eastern Daylight Time				07/20/2015 10:47:36 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	3	2016	Pennsylvania	South - Pennsylvania	2	1000	2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	4	1	01	01	H3954_156_4	5		1	07/08/2015	2016.01	07/08/2015 09:57:55 PM Eastern Daylight Time	07/17/2015 08:00:01 AM Eastern Daylight Time				07/20/2015 10:47:36 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	4	2016	Pennsylvania	Southeast - Pennsylvania	2	1000	2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	5	1	01	01	H3954_156_5	5		1	07/08/2015	2016.01	07/08/2015 09:58:02 PM Eastern Daylight Time	07/17/2015 08:00:01 AM Eastern Daylight Time				07/20/2015 10:47:36 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	5	2016	Pennsylvania	West - Pennsylvania	2	1000	2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	6	1	01	01	H3954_156_6	5		1	07/08/2015	2016.01	07/08/2015 09:58:15 PM Eastern Daylight Time	07/17/2015 08:00:00 AM Eastern Daylight Time				07/20/2015 10:47:36 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	6	2016	Pennsylvania	Southwest - Pennsylvania	2	1000	2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	157	1	1	01	01	H3954_157_1	6		1	07/08/2015	2016.01	07/08/2015 09:58:31 PM Eastern Daylight Time	08/04/2015 12:19:31 PM Eastern Daylight Time	08/04/2015 12:19:31 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	1	2016	Pennsylvania	Central - Pennsylvania	2	1000	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	2	1	01	01	H3954_157_2	6		1	07/08/2015	2016.01	07/08/2015 09:58:42 PM Eastern Daylight Time	08/04/2015 12:19:27 PM Eastern Daylight Time	08/04/2015 12:19:29 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	2	2016	Pennsylvania	Northeast - Pennsylvania	2	1000	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	3	1	01	01	H3954_157_3	6		1	07/08/2015	2016.01	07/08/2015 09:58:54 PM Eastern Daylight Time	08/04/2015 12:19:29 PM Eastern Daylight Time	08/04/2015 12:19:29 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	3	2016	Pennsylvania	South - Pennsylvania	2	1000	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	4	1	01	01	H3954_157_4	6		1	07/08/2015	2016.01	07/08/2015 09:59:05 PM Eastern Daylight Time	08/04/2015 12:19:29 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	4	2016	Pennsylvania	Southeast - Pennsylvania	2	1000	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	5	1	01	01	H3954_157_5	6		1	07/08/2015	2016.01	07/08/2015 09:59:16 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	5	2016	Pennsylvania	West - Pennsylvania	2	1000	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	6	1	01	01	H3954_157_6	6		1	07/08/2015	2016.01	07/08/2015 09:59:31 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	6	2016	Pennsylvania	Southwest - Pennsylvania	2	1000	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	1	1	01	01	H3954_158_1	7		1	07/13/2015	2016.01	07/13/2015 02:04:12 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	1	2016	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	158	2	1	01	01	H3954_158_2	7		1	07/13/2015	2016.01	07/13/2015 02:05:05 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	2	2016	Pennsylvania	Northeast - 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	3	1	01	01	H3954_158_3	7		1	07/13/2015	2016.01	07/13/2015 02:05:19 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	3	2016	Pennsylvania	South - 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	4	1	01	01	H3954_158_4	7		1	07/13/2015	2016.01	07/13/2015 02:05:36 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	4	2016	Pennsylvania	Southeast - 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	5	1	01	01	H3954_158_5	7		1	07/13/2015	2016.01	07/13/2015 02:06:13 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	5	2016	Pennsylvania	West - 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	6	1	01	01	H3954_158_6	7		1	07/13/2015	2016.01	07/13/2015 02:06:26 PM Eastern Daylight Time	08/04/2015 12:19:30 PM Eastern Daylight Time	08/04/2015 12:19:31 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	6	2016	Pennsylvania	Southwest - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	801	0	1	01	01	H3954_801_0	3		1	05/29/2015	2016.01	05/29/2015 02:10:07 PM Eastern Daylight Time	07/17/2015 07:59:53 AM Eastern Daylight Time				07/20/2015 10:47:36 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic (Employer Group) (HMO)	01	01		1			H3954	801	0	2016	Pennsylvania		1		2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	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	4		1	04/24/2015	2016.01	04/24/2015 08:27:57 PM Eastern Daylight Time	07/17/2015 07:59:54 AM Eastern Daylight Time				07/20/2015 10:47:36 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Rx (Employer Group) (HMO)	01	01		1			H3954	802	0	2016	Pennsylvania		1		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	003	0	1	01	01	H3957_003_0	7		1	07/08/2015	2016.01	07/08/2015 06:37:36 AM Eastern Daylight Time	08/03/2015 10:36:25 AM Eastern Daylight Time	07/30/2015 08:27:00 AM Eastern Daylight Time			08/03/2015 03:55:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO Standard (HMO)	01	01		1			H3957	003	0	2016	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	006	0	1	01	01	H3957_006_0	7		1	07/08/2015	2016.01	07/08/2015 06:37:45 AM Eastern Daylight Time	08/03/2015 10:36:50 AM Eastern Daylight Time	07/30/2015 08:27:18 AM Eastern Daylight Time			08/03/2015 03:55:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO Standard (HMO)	01	01		1			H3957	006	0	2016	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	020	0	1	01	01	H3957_020_0	7		1	07/08/2015	2016.01	07/08/2015 06:37:54 AM Eastern Daylight Time	08/03/2015 10:37:15 AM Eastern Daylight Time	07/30/2015 08:27:31 AM Eastern Daylight Time			08/03/2015 03:55:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO Deluxe (HMO)	01	01		1			H3957	020	0	2016	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	021	0	1	01	01	H3957_021_0	7		1	07/08/2015	2016.01	07/08/2015 06:38:03 AM Eastern Daylight Time	08/03/2015 10:37:41 AM Eastern Daylight Time	07/30/2015 08:27:43 AM Eastern Daylight Time			08/03/2015 03:55:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO Deluxe (HMO)	01	01		1			H3957	021	0	2016	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	024	0	1	01	01	H3957_024_0	6		1	07/10/2015	2016.01	07/10/2015 11:28:23 AM Eastern Daylight Time	05/28/2015 06:04:28 PM Eastern Daylight Time				07/10/2015 11:42:08 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO Basic (HMO)	01	01		1			H3957	024	0	2016	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(800)227-8210		(800)227-8210										2					2					2	2			
H3957	025	0	1	01	01	H3957_025_0	6		1	07/10/2015	2016.01	07/10/2015 11:28:43 AM Eastern Daylight Time	05/29/2015 08:33:52 AM Eastern Daylight Time				07/10/2015 11:42:08 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO Basic (HMO)	01	01		1			H3957	025	0	2016	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(800)227-8210		(800)227-8210										2					2					2	2			
H3957	031	0	1	01	01	H3957_031_0	8		1	07/10/2015	2016.01	07/10/2015 11:29:03 AM Eastern Daylight Time	08/03/2015 10:38:05 AM Eastern Daylight Time	07/30/2015 08:27:55 AM Eastern Daylight Time			08/03/2015 03:55:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO ValueRx (HMO)	01	01		1			H3957	031	0	2016	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	032	0	1	01	01	H3957_032_0	8		1	07/10/2015	2016.01	07/10/2015 11:29:33 AM Eastern Daylight Time	08/03/2015 10:38:30 AM Eastern Daylight Time	07/30/2015 08:28:08 AM Eastern Daylight Time			08/03/2015 03:55:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Security Blue HMO ValueRx (HMO)	01	01		1			H3957	032	0	2016	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	038	0	1	01	01	H3957_038_0	8		1	07/10/2015	2016.01	07/10/2015 11:31:08 AM Eastern Daylight Time	08/03/2015 10:38:56 AM Eastern Daylight Time	07/30/2015 08:28:22 AM Eastern Daylight Time			08/03/2015 03:55:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	038	0	2016	Western PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	039	0	1	01	01	H3957_039_0	7		1	07/08/2015	2016.01	07/08/2015 06:39:04 AM Eastern Daylight Time	08/03/2015 10:39:21 AM Eastern Daylight Time	07/30/2015 08:28:34 AM Eastern Daylight Time			08/03/2015 03:55:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Prestige (HMO)	01	01		1			H3957	039	0	2016	Western PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	040	0	1	01	01	H3957_040_0	11		1	08/04/2015	2016.01	08/04/2015 11:39:56 AM Eastern Daylight Time	08/04/2015 09:40:18 AM Eastern Daylight Time	07/30/2015 08:29:11 AM Eastern Daylight Time			08/04/2015 11:47:33 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	040	0	2016	North Central		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	041	0	1	01	01	H3957_041_0	11		1	08/04/2015	2016.01	08/04/2015 11:40:05 AM Eastern Daylight Time	08/04/2015 09:41:29 AM Eastern Daylight Time	07/30/2015 08:29:25 AM Eastern Daylight Time			08/04/2015 11:47:33 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkblueshield.com/medicare	Community Blue Medicare HMO Signature (HMO)	01	01		1			H3957	041	0	2016	North Central		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2	2			
H3957	805	0	1	01	01	H3957_805_0	4		1	04/22/2015	2016.01	04/22/2015 01:51:31 PM Eastern Daylight Time	05/29/2015 08:23:22 AM Eastern Daylight Time				06/01/2015 10:55:31 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkbcbs.com/medicare	Security Blue HMO MA (HMO)	01	01		1			H3957	805	0	2016	Western PA		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(800)227-8210		(800)227-8210										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1					1	2			
H3957	806	0	1	01	01	H3957_806_0	4		1	05/18/2015	2016.01	05/18/2015 02:27:45 PM Eastern Daylight Time	05/29/2015 08:23:53 AM Eastern Daylight Time				06/01/2015 10:55:31 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkbcbs.com/medicare	Security Blue HMO MA-PD (HMO)	01	01		1			H3957	806	0	2016	Western PA		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1					1	2			
H3957	808	0	1	01	01	H3957_808_0	4		1	04/22/2015	2016.01	04/22/2015 01:53:59 PM Eastern Daylight Time	05/29/2015 08:24:22 AM Eastern Daylight Time				06/01/2015 10:55:31 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkbcbs.com/medicare	Security Blue HMO MA-PD Non-Calendar (HMO)	01	01		1			H3957	808	0	2016	Western PA		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1					1	2			
H3957	810	0	1	01	01	H3957_810_0	3		1	05/18/2015	2016.01	05/18/2015 02:28:01 PM Eastern Daylight Time	05/29/2015 08:24:55 AM Eastern Daylight Time				06/01/2015 10:55:31 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkbcbs.com/medicare	Community Blue Medicare HMO MA (HMO)	01	01		1			H3957	810	0	2016	Western PA		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182										(711)-		(711)-		(800)227-8210		(800)227-8210										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1					1	2			
H3957	811	0	1	01	01	H3957_811_0	3		1	05/06/2015	2016.01	05/06/2015 09:53:52 AM Eastern Daylight Time	05/29/2015 08:25:26 AM Eastern Daylight Time				06/01/2015 10:55:31 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkbcbs.com/medicare	Community Blue Medicare HMO MA-PD (HMO)	01	01		1			H3957	811	0	2016	Western PA		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182		(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1					1	2			
H3957	812	0	1	01	01	H3957_812_0	3		1	04/22/2015	2016.01	04/22/2015 01:54:08 PM Eastern Daylight Time	05/29/2015 08:25:55 AM Eastern Daylight Time				06/01/2015 10:55:31 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Highmark Choice Company	www.highmarkbcbs.com/medicare	Community Blue Medicare HMO MA-PD Non-Calendar (HMO)	01	01		1			H3957	812	0	2016	Western PA		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182		(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1					1	2			
H3959	001	0	1	01	01	H3959_001_0	5		1	07/31/2015	2016.01	07/31/2015 08:38:23 PM Eastern Daylight Time	08/02/2015 11:11:07 AM Eastern Daylight Time	07/29/2015 05:26:05 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H3959	001	0	2016	Allegheny County		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	002	0	1	01	01	H3959_002_0	4		1	08/01/2015	2016.01	08/01/2015 05:41:50 PM Eastern Daylight Time	08/03/2015 09:16:34 AM Eastern Daylight Time	07/29/2015 05:26:24 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H3959	002	0	2016	Western Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	010	0	1	01	01	H3959_010_0	5		1	06/01/2015	2016.01	06/01/2015 05:47:55 PM Eastern Daylight Time	08/02/2015 11:18:43 AM Eastern Daylight Time	07/29/2015 05:26:44 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H3959	010	0	2016	Allegheny County		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	011	0	1	01	01	H3959_011_0	4		1	07/31/2015	2016.01	07/31/2015 08:42:10 PM Eastern Daylight Time	08/02/2015 11:17:45 AM Eastern Daylight Time	07/29/2015 05:27:03 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H3959	011	0	2016	Central and Western Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	031	0	1	01	01	H3959_031_0	3		1	07/31/2015	2016.01	07/31/2015 08:43:57 PM Eastern Daylight Time	08/02/2015 11:17:11 AM Eastern Daylight Time	07/29/2015 05:27:22 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H3959	031	0	2016	Philadelphia and Delaware Counties		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	032	0	1	01	01	H3959_032_0	3		1	07/31/2015	2016.01	07/31/2015 08:45:34 PM Eastern Daylight Time	08/02/2015 11:25:42 AM Eastern Daylight Time	07/29/2015 05:27:41 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver Plus (HMO)	01	01		1			H3959	032	0	2016	Northwestern Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	033	0	1	01	01	H3959_033_0	3		1	08/01/2015	2016.01	08/01/2015 10:16:34 PM Eastern Daylight Time	08/02/2015 11:16:25 AM Eastern Daylight Time	07/29/2015 05:28:00 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H3959	033	0	2016	Bucks, Chester and Montgomery		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	035	0	1	01	01	H3959_035_0	6	2	1	08/03/2015	2016.01	08/03/2015 08:55:38 AM Eastern Daylight Time	08/03/2015 09:27:24 AM Eastern Daylight Time	07/29/2015 05:28:21 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Cares (HMO SNP)	01	01		1			H3959	035	0	2016	Southeastern Pennsylvania		2		2			1	3		1	2			http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	036	0	1	01	01	H3959_036_0	6	2	1	08/03/2015	2016.01	08/03/2015 08:56:17 AM Eastern Daylight Time	08/03/2015 09:27:50 AM Eastern Daylight Time	07/29/2015 05:28:41 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Cares (HMO SNP)	01	01		1			H3959	036	0	2016	Central and Western Pennsylvania		2		2			1	3		1	2			http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	037	0	1	01	01	H3959_037_0	3		1	07/31/2015	2016.01	07/31/2015 08:56:59 PM Eastern Daylight Time	08/02/2015 11:14:14 AM Eastern Daylight Time	07/29/2015 05:29:00 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Northern Pennsylvania Gold (HMO)	01	01		1			H3959	037	0	2016	Northeastern Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	039	0	1	01	01	H3959_039_0	3		1	07/31/2015	2016.01	07/31/2015 08:50:11 PM Eastern Daylight Time	08/02/2015 11:13:25 AM Eastern Daylight Time	07/29/2015 05:29:19 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver Plus (HMO)	01	01		1			H3959	039	0	2016	Central Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	041	0	1	01	01	H3959_041_0	2		1	05/27/2015	2016.01	05/27/2015 12:15:48 PM Eastern Daylight Time	05/26/2015 10:18:54 PM Eastern Daylight Time				07/16/2015 04:23:19 PM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Basic Medical (HMO)	01	01		1			H3959	041	0	2016	Central and Western Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3959	043	0	1	01	01	H3959_043_0	7		1	07/31/2015	2016.01	07/31/2015 08:51:33 PM Eastern Daylight Time	08/02/2015 11:12:43 AM Eastern Daylight Time	07/29/2015 05:29:38 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Choice Plan (HMO)	01	01		1			H3959	043	0	2016	Allegheny County		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	044	0	1	01	01	H3959_044_0	6		1	07/31/2015	2016.01	07/31/2015 08:54:03 PM Eastern Daylight Time	08/02/2015 11:12:02 AM Eastern Daylight Time	07/29/2015 05:29:58 PM Eastern Daylight Time			08/03/2015 09:46:41 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Fayette Prime (HMO)	01	01		1			H3959	044	0	2016	Fayette County		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	803	0	1	01	01	H3959_803_0	2		1	05/28/2015	2016.01	05/28/2015 10:08:02 AM Eastern Daylight Time	07/17/2015 10:21:08 AM Eastern Daylight Time				07/17/2015 11:19:54 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	Advantra MA Only (HMO)	01	01		1			H3959	803	0	2016	Pennsylvania		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1					1	2			
H3959	804	0	1	01	01	H3959_804_0	2		1	05/28/2015	2016.01	05/28/2015 10:18:26 AM Eastern Daylight Time	07/16/2015 05:27:12 PM Eastern Daylight Time				07/16/2015 07:10:59 PM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H3959	804	0	2016	Pennsylvania		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272		(866)290-6660		(866)290-6660		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1					1	2			
H3962	001	0	1	01	01	H3962_001_0	8		1	07/16/2015	2016.01	07/16/2015 06:54:23 PM Eastern Daylight Time	07/30/2015 02:25:14 PM Eastern Daylight Time	07/30/2015 02:24:52 PM Eastern Daylight Time			07/31/2015 03:59:51 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	SeniorBlue - Option 1 (HMO)	01	01		1			H3962	001	0	2016	16 Counties in Central PA		2	5853	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	1	01	8a2;	
H3962	004	0	1	01	01	H3962_004_0	7		1	07/16/2015	2016.01	07/16/2015 06:55:37 PM Eastern Daylight Time	07/30/2015 02:24:40 PM Eastern Daylight Time	07/30/2015 02:24:18 PM Eastern Daylight Time			07/31/2015 03:59:51 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	SeniorBlue - Option 2 (HMO)	01	01		1			H3962	004	0	2016	16 Counties in Central PA		2	1228	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	1	01	8a2;	
H3962	007	0	1	01	01	H3962_007_0	7		1	07/16/2015	2016.01	07/16/2015 06:57:28 PM Eastern Daylight Time	07/30/2015 02:24:02 PM Eastern Daylight Time	07/30/2015 02:23:40 PM Eastern Daylight Time			07/31/2015 03:59:51 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	SeniorBlue - Option 3 (HMO)	01	01		1			H3962	007	0	2016	16 Counties in Central PA		2	3053	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	1	01	8a2;	
H3962	801	0	1	01	01	H3962_801_0	4		1	05/31/2015	2016.01	05/31/2015 12:46:43 AM Eastern Daylight Time	06/01/2015 03:09:38 PM Eastern Daylight Time				06/01/2015 03:57:56 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	SeniorBlue ER - With Rx (HMO)	01	01		1			H3962	801	0	2016	National		1	1433	2			2							www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3962	802	0	1	01	01	H3962_802_0	3		1	05/31/2015	2016.01	05/31/2015 12:51:32 AM Eastern Daylight Time	06/01/2015 03:08:58 PM Eastern Daylight Time				06/01/2015 03:57:56 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	SeniorBlue ER - w/o Rx (HMO)	01	01		1			H3962	802	0	2016	National		1	126	2			2							www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3962	803	0	1	01	01	H3962_803_0	3		1	05/31/2015	2016.01	05/31/2015 12:54:48 AM Eastern Daylight Time	06/01/2015 03:12:18 PM Eastern Daylight Time				06/01/2015 03:57:56 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	www.capitalbluemedicare.com	SeniorBlue ER - Non-Calendar - with Rx (HMO)	01	01		1			H3962	803	0	2016	National		1	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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H3979	001	0	1	01	01	H3979_001_0	6		1	07/16/2015	2016.01	07/16/2015 12:46:30 PM Central Daylight Time	08/03/2015 03:34:44 PM Central Daylight Time	08/03/2015 02:36:44 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemedicareok.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3979	001	0	2016	Oklahoma City Metro Area		2		2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3979	002	0	1	02	01	H3979_002_0	6		1	07/16/2015	2016.01	07/16/2015 12:48:25 PM Central Daylight Time	08/03/2015 03:35:20 PM Central Daylight Time	08/03/2015 02:39:04 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemedicareok.com	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H3979	002	0	2016	Oklahoma City Area		2		2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3979	801	0	1	01	01	H3979_801_0	3		1	05/28/2015	2016.01	05/28/2015 01:11:00 PM Central Daylight Time	07/16/2015 12:29:31 PM Central Daylight Time				07/16/2015 03:30:57 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemedicareok.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3979	801	0	2016	State of Oklahoma		1	5663	2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H3979	803	0	1	01	01	H3979_803_0	3		1	05/27/2015	2016.01	05/27/2015 11:04:53 AM Central Daylight Time	07/16/2015 12:29:58 PM Central Daylight Time				07/16/2015 03:30:57 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemedicareok.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3979	803	0	2016	State of Oklahoma		1	5663	2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H3979	805	0	1	01	01	H3979_805_0	3		1	05/01/2015	2016.01	05/01/2015 12:20:37 PM Mountain Daylight Time	07/16/2015 12:30:20 PM Central Daylight Time				07/16/2015 03:30:57 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemedicareok.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3979	805	0	2016	State of Oklahoma		1	5663	2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H4000	001	0	1	20	08	H4000_001_0	2		1	05/21/2015	2016.01	05/21/2015 08:09:36 PM Mountain Daylight Time		05/20/2015 01:32:20 PM Mountain Daylight Time			05/21/2015 08:11:56 PM Mountain Daylight Time	MEMORIAL HOSPITAL OF LARAMIE COUNTY	Wyoming PACE	www.crmcwy.org	001-Dual Eligible (PACE)	08	20		1			H4000	001	0	2016	001-Wyoming PACE		2		2			2								www.seniorscript.com	www.seniorscript.com									(000)000-0000		(307)634-2273		(000)000-0000		(307)634-2273										(800)877-9965		(800)877-9965		(800)877-9965		(800)877-9965																
H4000	002	0	1	20	08	H4000_002_0	2		1	05/21/2015	2016.01	05/21/2015 08:10:08 PM Mountain Daylight Time		05/20/2015 01:33:06 PM Mountain Daylight Time			05/21/2015 08:11:56 PM Mountain Daylight Time	MEMORIAL HOSPITAL OF LARAMIE COUNTY	Wyoming PACE	www.crmcwy.org	002-Medicare Only (PACE)	08	20		1			H4000	002	0	2016	002-Wyoming PACE		2		2			2								www.seniorscript.com	www.seniorscript.com									(000)000-0000		(307)634-2273		(000)000-0000		(307)634-2273										(800)877-9965		(800)877-9965		(800)877-9965		(800)877-9965																
H4003	009	0	1	01	01	H4003_009_0	8		1	07/12/2015	2016.01	07/12/2015 09:43:42 PM SA Western Standard Time	08/05/2015 05:48:51 PM SA Western Standard Time	08/05/2015 05:48:51 PM SA Western Standard Time			08/05/2015 06:06:13 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Supremo (HMO SNP)	01	01		1			H4003	009	0	2016	Puerto Rico		2		2			1	4		1		00000000000000000010		www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	12;	
H4003	015	0	1	01	01	H4003_015_0	8		1	08/05/2015	2016.01	08/05/2015 03:29:11 PM SA Western Standard Time	08/05/2015 07:33:04 PM SA Western Standard Time	08/07/2015 10:59:36 AM SA Western Standard Time			08/07/2015 11:08:48 AM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM- Unico Extra (HMO)	01	01		1			H4003	015	0	2016	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	12;	
H4003	017	0	1	01	01	H4003_017_0	10	1	1	08/05/2015	2016.01	08/05/2015 10:10:11 PM SA Western Standard Time	08/05/2015 09:28:24 PM SA Western Standard Time	08/05/2015 09:28:24 PM SA Western Standard Time			08/05/2015 10:28:13 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Diamante Choice Platino (HMO SNP)	01	01		1			H4003	017	0	2016	Puerto Rico		2		2		1	1	3		1	3		2	www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	2			
H4003	018	0	1	01	01	H4003_018_0	6		1	07/12/2015	2016.01	07/12/2015 09:45:19 PM SA Western Standard Time	07/17/2015 12:24:24 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Original (HMO)	01	01		1			H4003	018	0	2016	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396										(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655										2					2					2	1	01	12;	
H4003	019	0	1	01	01	H4003_019_0	7		1	07/12/2015	2016.01	07/12/2015 09:46:12 PM SA Western Standard Time	08/05/2015 05:48:51 PM SA Western Standard Time	08/05/2015 05:48:51 PM SA Western Standard Time			08/05/2015 06:06:13 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Unico (HMO)	01	01		1			H4003	019	0	2016	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	12;	
H4003	021	0	1	01	01	H4003_021_0	9	1	1	08/05/2015	2016.01	08/05/2015 05:07:46 PM SA Western Standard Time	08/05/2015 05:48:52 PM SA Western Standard Time	08/05/2015 05:48:52 PM SA Western Standard Time			08/05/2015 06:06:13 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Diamante Extra Platino (HMO SNP)	01	01		1			H4003	021	0	2016	Puerto Rico		2	1500	2		1	1	3		1	3		2	www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	2			
H4003	027	0	1	02	01	H4003_027_0	9		1	08/05/2015	2016.01	08/05/2015 11:23:49 AM SA Western Standard Time	08/05/2015 07:32:56 PM SA Western Standard Time	08/07/2015 10:59:36 AM SA Western Standard Time			08/07/2015 11:08:48 AM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Elite Ultra (HMO-POS)	01	02		1			H4003	027	0	2016	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	12;	
H4003	033	0	1	01	01	H4003_033_0	10	1	1	08/05/2015	2016.01	08/05/2015 10:10:27 PM SA Western Standard Time	08/05/2015 09:28:24 PM SA Western Standard Time	08/05/2015 09:28:24 PM SA Western Standard Time			08/05/2015 10:28:13 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Diamante Excel Platino (HMO SNP)	01	01		1			H4003	033	0	2016	Puerto Rico		2		2		1	1	3		1	3		2	www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	2			
H4003	034	0	1	02	01	H4003_034_0	11		1	08/07/2015	2016.01	08/07/2015 05:17:41 PM SA Western Standard Time	08/07/2015 06:14:12 PM SA Western Standard Time	08/05/2015 07:33:00 PM SA Western Standard Time			08/07/2015 06:19:13 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Elite Excel (HMO-POS)	01	02		1			H4003	034	0	2016	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2	1	01	12;	
H4003	803	0	1	02	01	H4003_803_0	6		1	07/08/2015	2016.01	07/08/2015 12:23:52 PM SA Western Standard Time	07/17/2015 12:50:56 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Flex A Calendar (HMO-POS)	01	02		1			H4003	803	0	2016	Puerto Rico		1	1500	2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;16b;18a;	2					2	2			
H4003	806	0	1	02	01	H4003_806_0	6		1	07/08/2015	2016.01	07/08/2015 12:24:18 PM SA Western Standard Time	07/17/2015 01:22:30 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Flex B Calendar (HMO-POS)	01	02		1			H4003	806	0	2016	Puerto Rico		1	1500	2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;16b;18a;	2					2	2			
H4003	807	0	1	02	01	H4003_807_0	6		1	07/08/2015	2016.01	07/08/2015 12:24:44 PM SA Western Standard Time	07/17/2015 01:28:38 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Flex C Non Calendar (HMO-POS)	01	02		1			H4003	807	0	2016	Puerto Rico		1	1500	2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;16b;18a;	2					2	2			
H4003	819	0	1	02	01	H4003_819_0	5		1	07/08/2015	2016.01	07/08/2015 12:25:10 PM SA Western Standard Time	07/17/2015 01:47:52 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	Medicare y Mucho Ms	www.mmm-pr.com	MMM - Flex D Non Calendar (HMO-POS)	01	02		1			H4003	819	0	2016	Puerto Rico		1	1500	2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;16b;18a;	2					2	2			
H4004	048	0	1	01	01	H4004_048_0	9	1	1	07/10/2015	2016.01	07/10/2015 07:15:48 PM SA Western Standard Time	08/05/2015 07:33:00 PM SA Western Standard Time	08/05/2015 07:32:50 PM SA Western Standard Time			08/05/2015 08:03:02 PM SA Western Standard Time	PMC MEDICARE CHOICE, LLC	PMC Medicare Choice	www.pmcpr.org	PMC - Premier Preferred Platino (HMO SNP)	01	01		1			H4004	048	0	2016	PUERTO RICO		2		2		1	1	3		1	3		2	www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		2					2					2	2			
H4004	053	0	1	02	01	H4004_053_0	8		1	08/03/2015	2016.01	08/03/2015 10:41:17 PM SA Western Standard Time	08/05/2015 07:33:02 PM SA Western Standard Time	08/07/2015 10:59:36 AM SA Western Standard Time			08/07/2015 11:08:48 AM SA Western Standard Time	PMC MEDICARE CHOICE, LLC	PMC Medicare Choice	www.pmcpr.org	PMC Max - Extra (HMO-POS)	01	02		1			H4004	053	0	2016	PUERTO RICO		2		2			2							www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		2					2					2	1	01	12;	
H4004	817	0	1	02	01	H4004_817_0	5		1	07/08/2015	2016.01	07/08/2015 12:25:36 PM SA Western Standard Time	07/17/2015 01:19:10 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	PMC MEDICARE CHOICE, LLC	PMC Medicare Choice	www.pmcpr.org	PMC - Max A Non Calendar (HMO-POS)	01	02		1			H4004	817	0	2016	Puerto Rico		1	1500	2			2							www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14d;14e;15;16b;18a;	1	1a;1b;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;16b;18a;	2					2	2			
H4005	001	0	1	04	01	H4005_001_0	7		1	07/28/2015	2016.01	07/28/2015 01:25:01 PM SA Western Standard Time	06/01/2015 08:56:25 AM SA Western Standard Time				07/28/2015 01:36:20 PM SA Western Standard Time	TRIPLE-S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	01	04		1			H4005	001	0	2016	Island of Puerto Rico		2	635	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2						2			
H4005	004	0	1	04	01	H4005_004_0	10		1	07/28/2015	2016.01	07/28/2015 01:26:50 PM SA Western Standard Time	08/05/2015 09:26:29 AM SA Western Standard Time	08/04/2015 10:16:07 AM SA Western Standard Time			08/05/2015 10:00:42 AM SA Western Standard Time	TRIPLE-S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo Plus (PPO)	01	04		1			H4005	004	0	2016	Island of Puerto Rico		2	9001	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		2					2						2			
H4005	006	0	1	04	01	H4005_006_0	9		1	07/28/2015	2016.01	07/28/2015 01:26:22 PM SA Western Standard Time	08/05/2015 09:26:38 AM SA Western Standard Time	08/04/2015 10:16:19 AM SA Western Standard Time			08/05/2015 10:00:42 AM SA Western Standard Time	TRIPLE-S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo Advance (PPO)	01	04		1			H4005	006	0	2016	Island of Puerto Rico		2	203	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		2					2						2			
H4005	801	0	1	04	01	H4005_801_0	6		1	06/04/2015	2016.01	06/04/2015 07:21:42 PM SA Western Standard Time	07/17/2015 05:56:18 PM SA Western Standard Time				07/20/2015 08:07:17 PM SA Western Standard Time	TRIPLE-S ADVANTAGE, INC.	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	01	04		1			H4005	801	0	2016	Island of Puerto Rico		1	99	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H4005	802	0	1	04	01	H4005_802_0	5		1	06/04/2015	2016.01	06/04/2015 07:23:19 PM SA Western Standard Time	06/01/2015 08:56:39 AM SA Western Standard Time				06/05/2015 05:25:58 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	2016	Island of Puerto Rico		1	13173	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H4005	804	0	1	04	01	H4005_804_0	5		1	06/04/2015	2016.01	06/04/2015 07:24:33 PM SA Western Standard Time	06/01/2015 08:56:42 AM SA Western Standard Time				06/05/2015 05:25:58 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	2016	Island of Puerto Rico		1	175	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H4005	807	0	1	04	01	H4005_807_0	6		1	06/04/2015	2016.01	06/04/2015 07:25:35 PM SA Western Standard Time	07/17/2015 05:58:48 PM SA Western Standard Time				07/20/2015 08:07:17 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	2016	Island of Puerto Rico		1	99	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H4007	012	0	1	01	01	H4007_012_0	3		1	07/08/2015	2016.01	07/08/2015 02:43:22 PM Eastern Daylight Time	08/04/2015 09:51:55 AM Eastern Daylight Time	07/29/2015 11:03:02 PM Eastern Daylight Time			08/04/2015 01:21:43 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Gold Plus H4007-012 (HMO)	01	01		1			H4007	012	0	2016	Puerto Rico Island Wide		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4007	013	0	1	01	01	H4007_013_0	3		1	07/08/2015	2016.01	07/08/2015 02:27:09 PM Eastern Daylight Time	08/04/2015 09:55:21 AM Eastern Daylight Time	07/29/2015 11:03:38 PM Eastern Daylight Time			08/04/2015 01:21:43 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Gold Plus H4007-013 (HMO)	01	01		1			H4007	013	0	2016	Puerto Rico Island Wide		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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	5	1	1	07/31/2015	2016.01	07/31/2015 10:00:41 AM Eastern Daylight Time	08/04/2015 10:08:25 AM Eastern Daylight Time	07/29/2015 11:04:14 PM Eastern Daylight Time			08/04/2015 03:31:35 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4007-016 (HMO SNP)	01	01		1			H4007	016	0	2016	Puerto Rico Island Wide		2		2		1	1	3		1	3		2		www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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	017	0	1	01	01	H4007_017_0	3		1	07/08/2015	2016.01	07/08/2015 02:27:38 PM Eastern Daylight Time	08/04/2015 10:11:43 AM Eastern Daylight Time	07/29/2015 11:04:50 PM Eastern Daylight Time			08/04/2015 01:21:43 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Gold Plus H4007-017 (HMO)	01	01		1			H4007	017	0	2016	Puerto Rico Island Wide		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4007	801	0	1	01	01	H4007_801_0	1		1	05/11/2015	2016.01	05/11/2015 02:22:38 PM Eastern Daylight Time	05/29/2015 08:11:07 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	801	0	2016	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4007	802	0	1	01	01	H4007_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:23:41 PM Eastern Daylight Time	05/29/2015 08:17:53 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	802	0	2016	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4007	805	0	1	01	01	H4007_805_0	1		1	05/11/2015	2016.01	05/11/2015 02:24:45 PM Eastern Daylight Time	05/29/2015 08:21:09 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	805	0	2016	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4007	806	0	1	01	01	H4007_806_0	1		1	05/11/2015	2016.01	05/11/2015 02:25:51 PM Eastern Daylight Time	05/29/2015 08:21:37 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	806	0	2016	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4007	808	0	1	01	01	H4007_808_0	1		1	05/11/2015	2016.01	05/11/2015 02:26:54 PM Eastern Daylight Time	05/29/2015 08:27:23 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	808	0	2016	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4007	809	0	1	01	01	H4007_809_0	1		1	05/11/2015	2016.01	05/11/2015 02:27:57 PM Eastern Daylight Time	05/29/2015 08:27:52 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	809	0	2016	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4011	010	0	1	04	01	H4011_010_0	6		1	07/10/2015	2016.01	07/10/2015 07:21:15 PM SA Western Standard Time	08/05/2015 05:52:47 PM SA Western Standard Time	08/05/2015 05:52:35 PM SA Western Standard Time			08/05/2015 06:06:13 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	First +Plus	www.firstpluspr.com	First+Plus Advantage (PPO)	01	04		1			H4011	010	0	2016	Puerto Rico		2		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2						1	01	8a1;8b1;8b2;8b3;9a;9b;11a;11b1;11b2;11c1;11c2;12;	
H4011	801	0	1	04	01	H4011_801_0	6		1	07/08/2015	2016.01	07/08/2015 12:25:56 PM SA Western Standard Time	07/17/2015 12:47:18 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	First +Plus	www.mmm-pr.com	First+Plus - Advantage Plus A Calendar (PPO)	01	04		1			H4011	801	0	2016	Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9a;9b;9c;11a;11b;11c;	2		1						2			
H4011	803	0	1	04	01	H4011_803_0	5		1	07/08/2015	2016.01	07/08/2015 12:26:09 PM SA Western Standard Time	07/17/2015 04:57:20 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	First +Plus	www.mmm-pr.com	First+Plus - Advantage Plus B Calendar (PPO)	01	04		1			H4011	803	0	2016	Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9a;9b;9c;11a;11b;11c;	2		1						2			
H4011	809	0	1	04	01	H4011_809_0	5		1	07/08/2015	2016.01	07/08/2015 12:26:23 PM SA Western Standard Time	07/17/2015 05:01:22 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC.	First +Plus	www.firstpluspr.com	First+Plus - Advantage Plus C Non Calendar (PPO)	01	04		1			H4011	809	0	2016	Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9a;9b;9c;11a;11b;11c;	2		1						2			
H4036	008	0	1	04	01	H4036_008_0	10		1	07/20/2015	2016.01	07/20/2015 09:47:39 AM Eastern Daylight Time	08/03/2015 04:15:19 PM Eastern Daylight Time	07/30/2015 06:39:25 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4036	008	0	2016	East and Southeast Wisconsin		2	1821	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7802		(855)690-7802		(800)797-5940		(800)797-5940		(855)690-7802		(855)690-7802		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	009	0	1	04	01	H4036_009_0	10		1	07/20/2015	2016.01	07/20/2015 09:49:27 AM Eastern Daylight Time	08/03/2015 04:15:56 PM Eastern Daylight Time	07/30/2015 06:36:25 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4036	009	0	2016	Central Wisconsin		2	376	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7802		(855)690-7802		(800)797-5940		(800)797-5940		(855)690-7802		(855)690-7802		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	010	1	1	04	01	H4036_010_1	10		1	07/20/2015	2016.01	07/20/2015 09:29:27 AM Eastern Daylight Time	08/01/2015 09:32:22 PM Eastern Daylight Time	07/30/2015 06:09:11 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4036	010	1	2016	Select Counties in Ohio	Segment 001	2	3533	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7802		(855)690-7802		(800)797-1765		(800)797-1765		(855)690-7802		(855)690-7802		(844)364-2120		(844)364-2120		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	010	2	1	04	01	H4036_010_2	10		1	07/20/2015	2016.01	07/20/2015 09:33:51 AM Eastern Daylight Time	08/01/2015 09:32:55 PM Eastern Daylight Time	07/30/2015 06:09:53 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4036	010	2	2016	Select Counties in Ohio	Segment 002	2	4637	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7802		(855)690-7802		(800)797-1765		(800)797-1765		(855)690-7802		(855)690-7802		(844)364-2120		(844)364-2120		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	012	1	1	04	01	H4036_012_1	10		1	07/20/2015	2016.01	07/20/2015 09:34:50 AM Eastern Daylight Time	08/01/2015 09:33:28 PM Eastern Daylight Time	07/30/2015 06:10:33 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access Enhanced (PPO)	01	04		1			H4036	012	1	2016	Select Counties in Ohio	Segment 001	2	519	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7802		(855)690-7802		(800)797-1765		(800)797-1765		(855)690-7802		(855)690-7802		(844)364-2120		(844)364-2120		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	012	2	1	04	01	H4036_012_2	10		1	07/20/2015	2016.01	07/20/2015 09:51:34 AM Eastern Daylight Time	08/01/2015 09:34:00 PM Eastern Daylight Time	07/30/2015 06:11:11 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access Enhanced (PPO)	01	04		1			H4036	012	2	2016	Select Counties in Ohio	Segment 002	2	5562	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7802		(855)690-7802		(800)797-1765		(800)797-1765		(855)690-7802		(855)690-7802		(844)364-2120		(844)364-2120		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	801	0	1	04	01	H4036_801_0	4		1	05/29/2015	2016.01	05/29/2015 12:19:26 PM Pacific Daylight Time	05/31/2015 09:38:43 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	2016	Wisconsin		1	3987	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H4036	802	0	1	04	01	H4036_802_0	4		1	05/29/2015	2016.01	05/29/2015 12:21:03 PM Pacific Daylight Time	05/31/2015 09:38:48 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	2016	Wisconsin		1	800	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H4036	803	0	1	04	01	H4036_803_0	4		1	05/29/2015	2016.01	05/29/2015 12:21:16 PM Pacific Daylight Time	05/31/2015 01:16:37 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	803	0	2016	Wisconsin		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H4036	805	0	1	04	01	H4036_805_0	4		1	05/29/2015	2016.01	05/29/2015 12:21:42 PM Pacific Daylight Time	05/31/2015 01:16:41 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	2016	National (ASO)		1	6626	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H4036	806	0	2	04	01	H4036_806_0	4		1	05/29/2015	2016.01	05/29/2015 12:22:06 PM Pacific Daylight Time	05/31/2015 01:16:47 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	2016	National (Part B Only)		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H4074	001	0	1	20	08	H4074_001_0	1		1	05/22/2015	2016.01	05/22/2015 09:25:58 AM Central Daylight Time		05/20/2015 11:22:12 AM Central Daylight Time			05/22/2015 09:34:30 AM Central Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	mercylifeal.com	Mercy LIFE of Alabama (PACE)	08	20		1			H4074	001	0	2016	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2								www.mercylifeal.com	www.mercylifeal.com									(251)287-2842		(251)287-8420		(251)287-8420		(251)287-8420										(251)287-8420		(251)287-8420		(251)287-8420		(251)287-8420																
H4074	002	0	1	20	08	H4074_002_0	1		1	05/22/2015	2016.01	05/22/2015 09:29:12 AM Central Daylight Time		05/20/2015 11:23:34 AM Central Daylight Time			05/22/2015 09:34:30 AM Central Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	mercylifeal.com	Mercy LIFE of Alabama (PACE)	08	20		1			H4074	002	0	2016	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2								www.mercylifeal.com	www.mercylifeal.com									(251)287-2842		(251)287-8420		(251)287-8420		(251)287-8420										(251)287-8420		(251)287-8420		(251)287-8420		(251)287-8420																
H4105	001	0	1	20	08	H4105_001_0	1		1	05/18/2015	2016.01	05/18/2015 02:36:36 PM Eastern Daylight Time		05/14/2015 03:27:37 PM Eastern Daylight Time			05/18/2015 02:47:00 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	2016	PACE Organization of Rhode Island		2		2			2								www.pace-ri.org	www.pace-ri.org									(877)781-7223		(401)490-6566		(877)781-7223		(401)490-6566										(866)883-1631		(401)490-4597		(866)883-1631		(401)490-4597																
H4105	002	0	1	20	08	H4105_002_0	1		1	05/18/2015	2016.01	05/18/2015 02:37:28 PM Eastern Daylight Time		05/14/2015 03:29:54 PM Eastern Daylight Time			05/18/2015 02:47:00 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	2016	PACE Organization of Rhode Island		2		2			2								www.pace-ri.org	www.pace-ri.org									(877)781-7223		(401)490-6566		(877)781-7223		(401)490-6566										(866)883-1631		(401)490-4597		(866)883-1631		(401)490-4597																
H4118	001	0	1	20	08	H4118_001_0	2		1	05/22/2015	2016.01	05/22/2015 03:55:06 PM Eastern Daylight Time		05/20/2015 02:30:19 PM Eastern Daylight Time			05/22/2015 03:56:17 PM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.hvpace.org	Huron Valley PACE - Dual Eligible (PACE)	08	20		1			H4118	001	0	2016	The Washtenaw PACE Inc.		2		2			2								www.hvpace.org	http://www.hometownpharmacy.com/									(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	2		1	05/22/2015	2016.01	05/22/2015 03:55:15 PM Eastern Daylight Time		05/20/2015 02:31:51 PM Eastern Daylight Time			05/22/2015 03:56:17 PM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.hvpace.org	Huron Valley PACE - Medicare Only (PACE)	08	20		1			H4118	002	0	2016	The Washtenaw PACE Inc.		2		2			2								www.hvpace.org	http://www.hometownpharmacy.com/									(855)483-7223		(734)572-5777		(855)483-7223		(734)572-5777										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777																
H4141	001	0	1	01	01	H4141_001_0	3		1	07/08/2015	2016.01	07/08/2015 12:47:17 PM Eastern Daylight Time	07/31/2015 04:12:51 PM Eastern Daylight Time	07/30/2015 11:59:54 AM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus H4141-001 (HMO)	01	01		1			H4141	001	0	2016	Atlanta Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	003	0	1	01	01	H4141_003_0	5	2	1	07/15/2015	2016.01	07/15/2015 11:26:24 AM Eastern Daylight Time	08/02/2015 10:12:43 AM Eastern Daylight Time	07/30/2015 12:00:30 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4141-003 (HMO SNP)	01	01		1			H4141	003	0	2016	Atlanta Metro Area		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	004	0	1	01	01	H4141_004_0	3		1	07/08/2015	2016.01	07/08/2015 12:48:06 PM Eastern Daylight Time	07/31/2015 04:03:17 PM Eastern Daylight Time	07/29/2015 11:06:36 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus H4141-004 (HMO)	01	01		1			H4141	004	0	2016	Greater Georgia		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	008	0	1	01	01	H4141_008_0	3		1	07/08/2015	2016.01	07/08/2015 12:48:28 PM Eastern Daylight Time	08/01/2015 06:41:41 PM Eastern Daylight Time	07/29/2015 11:07:12 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus H4141-008 (HMO)	01	01		1			H4141	008	0	2016	Catoosa, Dade and Walker counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	009	0	1	01	01	H4141_009_0	6		1	07/15/2015	2016.01	07/15/2015 11:26:39 AM Eastern Daylight Time	07/31/2015 04:02:22 PM Eastern Daylight Time	07/30/2015 12:01:06 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H4141	009	0	2016	Atlanta Metro Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	010	0	1	01	01	H4141_010_0	5	2	1	07/31/2015	2016.01	07/31/2015 12:55:55 PM Eastern Daylight Time	07/31/2015 10:59:46 AM Eastern Daylight Time	07/29/2015 11:08:22 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4141-010 (HMO SNP)	01	01		1			H4141	010	0	2016	Greater Georgia		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 09:33:02 AM Eastern Daylight Time	08/01/2015 06:42:37 PM Eastern Daylight Time	07/29/2015 11:08:58 PM Eastern Daylight Time			08/04/2015 01:18:14 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus H4141-015 (HMO)	01	01		1			H4141	015	0	2016	Atlanta Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/11/2015	2016.01	05/11/2015 02:29:22 PM Eastern Daylight Time	05/29/2015 08:12:34 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4141	801	0	2016	Select counties in Georgia		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4141	802	0	1	01	01	H4141_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:30:40 PM Eastern Daylight Time	05/29/2015 08:14:08 AM Eastern Daylight Time				05/29/2015 12:47:47 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4141	802	0	2016	Select counties in Georgia		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4142	001	0	1	20	08	H4142_001_0	2		1	05/20/2015	2016.01	05/20/2015 01:04:09 PM Central Daylight Time		05/20/2015 03:35:44 PM Central Daylight Time			05/21/2015 07:16:11 AM Central Daylight Time	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	Cherokee Elder Care	http://eldercare.cherokee.org	Cherokee Elder Care (PACE)	08	20		1			H4142	001	0	2016	Cherokee and surrounding counties		2	1424	2			2								eldercare.cherokee.org	eldercare.cherokee.org									(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554										(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554																
H4142	002	0	1	20	08	H4142_002_0	2		1	05/18/2015	2016.01	05/18/2015 11:01:21 AM Central Daylight Time		05/20/2015 03:42:34 PM Central Daylight Time			05/21/2015 07:16:11 AM Central Daylight Time	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	Cherokee Elder Care	http://eldercare.cherokee.org	Cherokee Elder Care (PACE)	08	20		1			H4142	002	0	2016	Cherokee and surrounding counties		2	132	2			2								eldercare.cherokee.org	eldercare.cherokee.org									(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554										(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554																
H4145	001	0	1	01	01	H4145_001_0	3		1	07/08/2015	2016.01	07/08/2015 08:28:11 AM Eastern Daylight Time	08/03/2015 11:10:59 AM Eastern Daylight Time	07/29/2015 11:09:34 PM Eastern Daylight Time			08/04/2015 01:36:39 PM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana Regional Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H4145-001 (HMO)	01	01		1			H4145	001	0	2016	Canadian, Cleveland and Oklahoma counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4145	002	0	1	01	01	H4145_002_0	3		1	07/08/2015	2016.01	07/08/2015 08:28:18 AM Eastern Daylight Time	08/03/2015 11:09:49 AM Eastern Daylight Time	07/29/2015 11:10:08 PM Eastern Daylight Time			08/04/2015 01:36:39 PM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana Regional Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H4145-002 (HMO)	01	01		1			H4145	002	0	2016	Okmulgee and Tulsa counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4145	801	0	1	01	01	H4145_801_0	1		1	05/11/2015	2016.01	05/11/2015 02:32:00 PM Eastern Daylight Time	05/29/2015 08:29:21 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana Regional Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4145	801	0	2016	Select Counties in Oklahoma		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4145	802	0	1	01	01	H4145_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:33:06 PM Eastern Daylight Time	05/29/2015 08:29:51 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana Regional Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4145	802	0	2016	Select Counties in Oklahoma		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4152	004	0	1	01	01	H4152_004_0	10		1	07/23/2015	2016.01	07/23/2015 03:34:13 PM Eastern Daylight Time	07/20/2015 04:24:44 PM Eastern Daylight Time				07/23/2015 03:46:20 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	2016	State of Rhode Island		2	988	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4152	005	0	1	01	01	H4152_005_0	14		1	07/23/2015	2016.01	07/23/2015 03:34:09 PM Eastern Daylight Time	07/31/2015 02:26:09 PM Eastern Daylight Time	07/31/2015 01:26:42 PM Eastern Daylight Time			08/05/2015 04:08:58 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	2016	State of Rhode Island		2	4082	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(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	007	0	1	02	01	H4152_007_0	14		1	08/05/2015	2016.01	08/05/2015 03:27:35 PM Eastern Daylight Time	07/31/2015 02:21:18 PM Eastern Daylight Time	07/31/2015 01:31:42 PM Eastern Daylight Time			08/05/2015 04:08:58 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	2016	State of Rhode Island		2	1872	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(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	013	0	1	01	01	H4152_013_0	12		1	08/05/2015	2016.01	08/05/2015 11:05:19 AM Eastern Daylight Time	07/31/2015 02:25:03 PM Eastern Daylight Time	07/31/2015 01:34:15 PM Eastern Daylight Time			08/05/2015 04:08:58 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	2016	State of Rhode Island		2	7590	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(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	016	0	1	02	01	H4152_016_0	14		1	08/05/2015	2016.01	08/05/2015 03:28:00 PM Eastern Daylight Time	08/14/2015 12:49:39 PM Eastern Daylight Time	07/31/2015 01:23:47 PM Eastern Daylight Time			08/14/2015 03:13:45 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Value (HMO-POS)	01	02		1			H4152	016	0	2016	State of Rhode Island		2	14014	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(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	017	0	1	01	01	H4152_017_0	15		1	09/14/2015	2016.01	09/14/2015 09:28:41 AM Eastern Daylight Time	08/10/2015 05:37:12 PM Eastern Daylight Time	07/31/2015 11:33:42 AM Eastern Daylight Time			09/14/2015 09:50:58 AM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Advance (HMO)	01	01		1			H4152	017	0	2016	State of Rhode Island		2	17479	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4152	018	0	1	02	01	H4152_018_0	13		1	08/05/2015	2016.01	08/05/2015 03:28:32 PM Eastern Daylight Time	08/03/2015 05:48:46 PM Eastern Daylight Time	07/31/2015 11:34:27 AM Eastern Daylight Time			08/05/2015 04:08:58 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	2016	State of Rhode Island		2	2525	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4152	815	0	1	02	01	H4152_815_0	8		1	05/29/2015	2016.01	05/29/2015 08:55:34 AM Eastern Daylight Time	06/01/2015 03:54:14 PM Eastern Daylight Time				06/01/2015 05:12:56 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.bcbsri.com	BlueCHiP for Medicare Group Preferred (HMO-POS)	01	02		1			H4152	815	0	2016	RI, Bristol Cty MA, Partial New London Cty CT		1	2973	2			2							http://findadoctor.bcbsri.com/	www.bcbsri.com	www.bcbsri.com	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;15;	2		1	2			
H4152	817	0	1	01	01	H4152_817_0	8		1	05/28/2015	2016.01	05/28/2015 11:50:20 AM Eastern Daylight Time	06/01/2015 03:53:23 PM Eastern Daylight Time				06/01/2015 05:12:56 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.bcbsri.com	BlueCHiP for Medicare Group Plus (HMO)	01	01		1			H4152	817	0	2016	RI, Bristol Cty MA, Partial New London Cty CT		1	659	2			2							http://findadoctor.bcbsri.com/	www.bcbsri.com	www.bcbsri.com	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1	2			
H4198	001	0	1	01	01	H4198_001_0	3		1	07/09/2015	2016.01	07/09/2015 04:34:06 PM Central Daylight Time	06/01/2015 05:58:49 PM Central Daylight Time				07/09/2015 04:40:52 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Government Programs	http://www.ccok.com/	Advantage Choice (HMO)	01	01		1			H4198	001	0	2016	Tulsa Metro Area		2	161	2			2								http://www.ccok.com/rxFormulary/isRxFormulary.dll/9AfN31cnXu2HMfRizN9utW/$/?switch=2	http://www.ccok.com/directory/Pdirectory.dll/nclnhcVDzeofUK9jtXhomG/$/?busunit=01&progno=MS	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323										(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353										2					2					2	2			
H4198	003	0	1	01	01	H4198_003_0	4		1	07/10/2015	2016.01	07/10/2015 01:20:36 PM Central Daylight Time	08/05/2015 09:30:52 AM Central Daylight Time	08/05/2015 09:30:52 AM Central Daylight Time			08/05/2015 09:50:35 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Government Programs	http://www.ccok.com/	Advantage Premier (HMO)	01	01		1			H4198	003	0	2016	Tulsa Metro Area		2	1139	2			2								http://www.ccok.com/rxFormulary/isRxFormulary.dll/9AfN31cnXu2HMfRizN9utW/$/?switch=2	http://www.ccok.com/directory/Pdirectory.dll/nclnhcVDzeofUK9jtXhomG/$/?busunit=01&progno=MS	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2	2			
H4198	005	0	1	01	01	H4198_005_0	5		1	08/03/2015	2016.01	08/03/2015 08:55:02 AM Central Daylight Time	08/05/2015 09:30:53 AM Central Daylight Time	08/05/2015 09:30:53 AM Central Daylight Time			08/05/2015 09:50:35 AM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Government Programs	http://www.ccok.com/	Advantage Choice Plus (HMO)	01	01		1			H4198	005	0	2016	Tulsa Metro Area		2	44	2			2								http://www.ccok.com/rxFormulary/isRxFormulary.dll/9AfN31cnXu2HMfRizN9utW/$/?switch=2	http://www.ccok.com/directory/Pdirectory.dll/nclnhcVDzeofUK9jtXhomG/$/?busunit=01&progno=MS	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2	2			
H4198	801	0	1	01	01	H4198_801_0	3		1	07/09/2015	2016.01	07/09/2015 04:34:47 PM Central Daylight Time	06/01/2015 05:58:50 PM Central Daylight Time				07/09/2015 04:40:52 PM Central Daylight Time	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	CommunityCare Government Programs	http://www.ccok.com/	Advantage (HMO)	01	01		1			H4198	801	0	2016	Tulsa Metro Area		1	156	2			2								http://www.ccok.com/rxFormulary/isRxFormulary.dll/9AfN31cnXu2HMfRizN9utW/$/?switch=2	http://www.ccok.com/directory/Pdirectory.dll/nclnhcVDzeofUK9jtXhomG/$/?busunit=01&progno=MS	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(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			
H4203	001	0	1	20	08	H4203_001_0	1		1	05/19/2015	2016.01	05/19/2015 10:08:49 AM Eastern Daylight Time		05/18/2015 02:53:47 PM Eastern Daylight Time			05/19/2015 10:16:18 AM Eastern Daylight Time	PALMETTO HEALTH ALLIANCE	Palmetto SeniorCare	www.palmettohealth.org	Palmetto Health - Palmetto SeniorCare (PACE)	08	20		1			H4203	001	0	2016	Richland and  Lexington Counties		2		2			2								n/a	N/A									(803)931-8175		(803)931-8175		(803)931-8175		(803)931-8175										(803)434-7000		(803)434-7000		(803)434-7000		(803)434-7000																
H4203	002	0	1	20	08	H4203_002_0	1		1	05/19/2015	2016.01	05/19/2015 10:08:22 AM Eastern Daylight Time		05/18/2015 03:34:37 PM Eastern Daylight Time			05/19/2015 10:16:18 AM Eastern Daylight Time	PALMETTO HEALTH ALLIANCE	Palmetto SeniorCare	www.palmettohealth.org	Palmetto Health - Palmetto SeniorCare (PACE)	08	20		1			H4203	002	0	2016	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	8		1	07/09/2015	2016.01	07/09/2015 12:38:10 PM Central Daylight Time	07/15/2015 05:30:24 PM Central Daylight Time				07/15/2015 05:34:14 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	04	09	1	1			H4213	016	1	2016	State of Arkansas	Northwest, some Eastern, and Southern AR counties	2	3156	2			2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	016	2	1	09	04	H4213_016_2	8		1	07/09/2015	2016.01	07/09/2015 12:38:49 PM Central Daylight Time	07/15/2015 05:30:25 PM Central Daylight Time				07/15/2015 05:34:14 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	04	09	1	1			H4213	016	2	2016	State of Arkansas	Some Central, Southern, and Eastern AR counties	2	891	2			2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	016	3	1	09	04	H4213_016_3	8		1	07/09/2015	2016.01	07/09/2015 12:39:21 PM Central Daylight Time	07/15/2015 05:30:25 PM Central Daylight Time				07/15/2015 05:34:14 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	04	09	1	1			H4213	016	3	2016	State of Arkansas	Benton, Carroll, Madison and Washington Counties	2	1713	2			2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	016	4	1	09	04	H4213_016_4	8		1	07/09/2015	2016.01	07/09/2015 12:39:50 PM Central Daylight Time	07/15/2015 05:30:24 PM Central Daylight Time				07/15/2015 05:34:14 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	04	09	1	1			H4213	016	4	2016	State of Arkansas	Central Arkansas counties	2	970	2			2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	017	1	1	09	04	H4213_017_1	7		1	07/09/2015	2016.01	07/09/2015 12:40:14 PM Central Daylight Time	08/04/2015 02:47:11 PM Central Daylight Time	08/04/2015 02:47:12 PM Central Daylight Time			08/04/2015 02:54:34 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	04	09	1	1			H4213	017	1	2016	State of Arkansas	Northwest, some Eastern and Southern AR counties	2	4852	2			2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4213	017	2	1	09	04	H4213_017_2	8		1	07/09/2015	2016.01	07/09/2015 12:40:52 PM Central Daylight Time	08/04/2015 02:47:13 PM Central Daylight Time	08/04/2015 02:47:14 PM Central Daylight Time			08/04/2015 02:54:34 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	04	09	1	1			H4213	017	2	2016	State of Arkansas	Some Central, Southern and Eastern AR counties	2	1369	2			2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4213	017	5	1	09	04	H4213_017_5	7		1	07/09/2015	2016.01	07/09/2015 12:41:27 PM Central Daylight Time	08/04/2015 02:47:15 PM Central Daylight Time	08/04/2015 02:47:16 PM Central Daylight Time			08/04/2015 02:54:34 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	04	09	1	1			H4213	017	5	2016	State of Arkansas	Benton, Carroll, Madison, Washington counties	2	2633	2			2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4213	017	6	1	09	04	H4213_017_6	8		1	07/09/2015	2016.01	07/09/2015 12:41:53 PM Central Daylight Time	08/04/2015 02:47:16 PM Central Daylight Time	08/04/2015 02:47:17 PM Central Daylight Time			08/04/2015 02:54:34 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	04	09	1	1			H4213	017	6	2016	State of Arkansas	Cleburne, Jefferson, Lonoke, Pulaski	2	1491	2			2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4227	001	0	1	01	01	H4227_001_0	16	2	1	08/04/2015	2016.01	08/04/2015 09:36:53 AM Central Daylight Time	08/03/2015 03:11:36 PM Central Daylight Time	08/03/2015 03:11:36 PM Central Daylight Time			08/04/2015 02:12:44 PM Central Daylight Time	VISTA HEALTH PLAN, INC.	Vista Health Plan, Inc.	www.keystonevipchoice.com	Keystone VIP Choice (HMO SNP)	01	01		1			H4227	001	0	2016	Eastern Pennsylvania		2	2163	2			1	3		1	5			www.keystonevipchoice.com	www.keystonevipchoice.com	http://keystonevipchoice.com/	(800)450-1166		(800)450-1166		(855)241-3648		(855)241-3648		(866)828-0021		(866)828-0021		(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	15	2	1	08/04/2015	2016.01	08/04/2015 09:37:48 AM Central Daylight Time	08/03/2015 03:11:36 PM Central Daylight Time	08/03/2015 03:11:36 PM Central Daylight Time			08/04/2015 02:12:44 PM Central Daylight Time	VISTA HEALTH PLAN, INC.	Vista Health Plan, Inc.	www.amerihealthvipcare.com	AmeriHealth VIP Care (HMO SNP)	01	01		1			H4227	002	0	2016	Eastern Pennsylvania		2	158	2			1	3		1	5			www.amerihealthvipcare.com	www.amerihealthvipcare.com	http://www.amerihealthvipcare.com/	(866)533-5490		(866)533-5490		(855)241-3648		(855)241-3648		(866)429-8918		(866)429-8918		(855)241-3648		(855)241-3648		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4235	001	0	1	20	08	H4235_001_0	2		1	05/21/2015	2016.01	05/21/2015 01:10:39 PM Eastern Daylight Time		05/18/2015 01:31:44 PM Eastern Daylight Time			05/21/2015 01:12:52 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	2016	Gaston County and Parts of Cleveland and Lincoln		2		2			2							www.seniortlc.org	www.seniorTLC.org	www.seniortlc.org									(855)327-7852		(704)874-0600		(855)327-7852		(704)874-0600										(704)874-3307		(704)874-3307		(704)874-3307		(704)874-3307																
H4235	002	0	1	20	08	H4235_002_0	2		1	05/21/2015	2016.01	05/21/2015 01:11:07 PM Eastern Daylight Time		05/18/2015 01:32:41 PM Eastern Daylight Time			05/21/2015 01:12:52 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	2016	Gaston, Lincoln and Cleveland Counties in NC		2		2			2							www.seniortlc.org	www.seniorTLC.org	www.seniortlc.org									(855)327-7852		(704)874-0600		(855)327-7852		(704)874-0600										(704)874-3307		(704)874-3307		(704)874-3307		(704)874-3307																
H4279	001	0	1	01	01	H4279_001_0	9	2	1	08/05/2015	2016.01	08/05/2015 02:41:11 PM Eastern Daylight Time	08/05/2015 01:41:47 PM Eastern Daylight Time	07/29/2015 04:33:59 PM Eastern Daylight Time			08/05/2015 04:19:38 PM Eastern Daylight Time	UPMC FOR YOU, INC	UPMC for You	www.upmchealthplan.com/snp	UPMC for Life Dual (HMO SNP)	01	01		1			H4279	001	0	2016	Western PA		2	20000	2			1	3		1	5			http://www.upmchealthplan.com/snp	http://www.upmchealthplan.com/snp/learn/plan-benefits/prescription-drug-coverage/	http://www.upmchealthplan.com/snp/learn/plan-benefits/prescription-drug-coverage/	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		2					2					2	2			
H4305	001	0	1	20	08	H4305_001_0	2		1	05/20/2015	2016.01	05/20/2015 02:13:40 PM Central Daylight Time		05/21/2015 09:26:43 AM Central Daylight Time			05/21/2015 09:32:41 AM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	n/a	Total Life Healthcare Dual (PACE)	08	20		1			H4305	001	0	2016	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										(800)336-0117		(870)336-0117		(800)336-0017		(870)336-0017																
H4305	002	0	1	20	08	H4305_002_0	2		1	05/20/2015	2016.01	05/20/2015 02:14:48 PM Central Daylight Time		05/21/2015 09:26:33 AM Central Daylight Time			05/21/2015 09:32:41 AM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	n/a	Total Life Healthcare Medicare only (PACE)	08	20		1			H4305	002	0	2016	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										(800)336-0117		(870)336-0117		(800)336-0017		(870)336-0017																
H4326	001	0	1	20	08	H4326_001_0	2		1	05/21/2015	2016.01	05/21/2015 05:28:34 PM Eastern Daylight Time		05/21/2015 05:26:00 PM Eastern Daylight Time			05/21/2015 05:34:29 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	2016	PACE at Home - dual		2		2			2								www.pace-at-home.org	www.seniorscript.com									(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980																
H4326	002	0	1	20	08	H4326_002_0	2		1	05/21/2015	2016.01	05/21/2015 05:28:52 PM Eastern Daylight Time		05/21/2015 05:26:00 PM Eastern Daylight Time			05/21/2015 05:34:29 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	2016	PACE at Home - medicare only		2		2			2								www.pace-at-home.org	www.seniorscript.com									(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980																
H4346	001	0	1	01	01	H4346_001_0	5		1	08/03/2015	2016.01	08/03/2015 04:38:02 PM Pacific Daylight Time	08/04/2015 02:12:37 PM Pacific Daylight Time	07/29/2015 03:09:46 PM Pacific Daylight Time			08/04/2015 05:23:09 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H4346	001	0	2016	Clark County (partial)		2	2558	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	005	0	1	01	01	H4346_005_0	5		1	08/03/2015	2016.01	08/03/2015 04:24:24 PM Pacific Daylight Time	08/04/2015 02:14:14 PM Pacific Daylight Time	07/29/2015 03:10:04 PM Pacific Daylight Time			08/04/2015 05:23:09 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H4346	005	0	2016	Clark County (partial)		2	558	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	006	0	1	01	01	H4346_006_0	5		1	08/03/2015	2016.01	08/03/2015 04:24:50 PM Pacific Daylight Time	08/04/2015 02:13:51 PM Pacific Daylight Time	07/29/2015 03:10:26 PM Pacific Daylight Time			08/04/2015 05:23:09 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	www.caremore.com	CareMore Diabetes (HMO SNP)	01	01		1			H4346	006	0	2016	Clark County (partial)		2	1390	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	008	0	1	01	01	H4346_008_0	5		1	08/03/2015	2016.01	08/03/2015 04:25:25 PM Pacific Daylight Time	08/04/2015 02:14:38 PM Pacific Daylight Time	07/29/2015 03:10:44 PM Pacific Daylight Time			08/04/2015 05:23:09 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore Heart (HMO SNP)	01	01		1			H4346	008	0	2016	Clark County (partial)		2	425	2			1	4		1		00000000000000000010		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	009	0	1	01	01	H4346_009_0	5		1	08/03/2015	2016.01	08/03/2015 04:26:00 PM Pacific Daylight Time	08/04/2015 02:13:01 PM Pacific Daylight Time	07/29/2015 03:11:01 PM Pacific Daylight Time			08/04/2015 05:23:09 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	www.caremore.com	CareMore StartSmart Plus (HMO)	01	01		1			H4346	009	0	2016	Clark County (partial)		2	652	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	010	0	1	01	01	H4346_010_0	5		1	08/03/2015	2016.01	08/03/2015 04:26:37 PM Pacific Daylight Time	08/04/2015 02:13:24 PM Pacific Daylight Time	07/29/2015 03:11:19 PM Pacific Daylight Time			08/04/2015 05:23:09 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore Touch (HMO SNP)	01	01		1			H4346	010	0	2016	Clark County (partial)		2	350	2			1	1	3	1				www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	011	0	1	01	01	H4346_011_0	6		1	07/07/2015	2016.01	07/07/2015 10:39:43 AM Pacific Daylight Time	08/04/2015 02:09:25 PM Pacific Daylight Time	07/29/2015 03:11:37 PM Pacific Daylight Time			08/04/2015 05:23:09 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore Connect Plus (HMO)	01	01		1			H4346	011	0	2016	Clark County (partial)		2	100	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(888)426-5985		(888)426-5985		(866)622-2820		(866)622-2820		(888)426-5985		(888)426-5985		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	801	0	1	01	01	H4346_801_0	2		1	05/19/2015	2016.01	05/19/2015 12:34:54 PM Pacific Daylight Time	05/29/2015 07:31:36 PM Pacific Daylight Time				05/30/2015 02:56:42 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore EGWP (HMO)	01	01		1			H4346	801	0	2016	Nevada		1	14	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4346	802	0	1	01	01	H4346_802_0	2		1	05/19/2015	2016.01	05/19/2015 12:30:16 PM Pacific Daylight Time	05/29/2015 07:31:14 PM Pacific Daylight Time				05/30/2015 02:56:42 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H4346	802	0	2016	Nevada		1	14	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	804	0	1	01	01	H4346_804_0	2		1	05/19/2015	2016.01	05/19/2015 12:29:03 PM Pacific Daylight Time	05/29/2015 07:31:58 PM Pacific Daylight Time				05/30/2015 02:56:42 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H4346	804	0	2016	Nevada		1	5	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4388	001	0	1	07	02	H4388_001_0	3		2	05/27/2015	2016.01	05/27/2015 09:14:06 AM Central Daylight Time			05/29/2015 10:26:39 AM Central Daylight Time		05/29/2015 03:29:22 PM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org	Secure Saver (MSA)	02	07	2	1			H4388	001	0	2016	Wisconsin statewide		2		2			2							www.securityhealth.org/medicareproviders	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicarepharmacies	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897										(711)-		(711)-		(711)-		(711)-																								
H4393	001	0	1	20	08	H4393_001_0	1		1	06/01/2015	2016.01	06/01/2015 10:16:45 AM Eastern Daylight Time		06/01/2015 09:12:44 AM Eastern Daylight Time			06/01/2015 10:22:24 AM Eastern Daylight Time	CATHOLIC MANAGED LONG TERM CARE, INC.	ArchCare Senior Life	http://www.archcare.org/	ArchCare Senior Life - Dual (PACE)	08	20		1			H4393	001	0	2016	New York, Bronx, and Richmond counties		2		2			2								www.archcare.org	www.archcare.org									(866)412-5435		(866)412-5435		(866)263-9083		(866)263-9083										(866)236-1069		(866)236-1069		(800)662-1220		(800)662-1220																
H4393	002	0	1	20	08	H4393_002_0	1		1	06/01/2015	2016.01	06/01/2015 10:17:49 AM Eastern Daylight Time		06/01/2015 09:13:36 AM Eastern Daylight Time			06/01/2015 10:22:24 AM Eastern Daylight Time	CATHOLIC MANAGED LONG TERM CARE, INC.	ArchCare Senior Life	http://www.archcare.org/	ArchCare Senior Life - Medicare only (PACE)	08	20		1			H4393	002	0	2016	New York, Bronx, and Richmond counties		2		2			2								www.archcare.org	www.archcare.org									(866)412-5435		(866)412-5435		(866)263-9083		(866)263-9083										(866)236-1069		(866)236-1069		(800)662-1220		(800)662-1220																
H4402	001	0	1	20	08	H4402_001_0	2		1	05/21/2015	2016.01	05/21/2015 06:58:53 AM Eastern Daylight Time		05/20/2015 03:38:22 PM Eastern Daylight Time			05/21/2015 07:09:50 AM Eastern Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	WWW.alexianbrotherssoutheast.com	Alexian Brothers Community Services (PACE)	08	20		1			H4402	001	0	2016	Hamilton County Area		2		2			2								None	None									(800)443-8883		(423)698-0802		(800)443-8883		(423)698-0802										(800)443-8883		(423)698-0802		(800)443-8883		(423)698-0802																
H4402	002	0	1	20	08	H4402_002_0	2		1	05/21/2015	2016.01	05/21/2015 06:59:08 AM Eastern Daylight Time		05/20/2015 03:44:08 PM Eastern Daylight Time			05/21/2015 07:09:50 AM Eastern Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	WWW.alexianbrotherssoutheast.com	Alexian Brothers Community Services (PACE)	08	20		1			H4402	002	0	2016	Hamilton County Area		2		2			2								None	None									(800)441-8883		(423)698-0802		(800)443-8883		(423)698-0802										(800)441-8883		(423)698-0802		(800)443-8883		(423)698-0802																
H4407	004	0	1	01	01	H4407_004_0	6	2	1	07/31/2015	2016.01	07/31/2015 01:21:30 PM Central Daylight Time	08/01/2015 09:46:46 AM Central Daylight Time	07/30/2015 08:22:47 AM Central Daylight Time			08/03/2015 03:57:29 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare SMS (HMO SNP)	01	01		1			H4407	004	0	2016	Southern Mississippi		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	011	0	1	01	01	H4407_011_0	5		1	07/09/2015	2016.01	07/09/2015 04:42:25 PM Central Daylight Time	07/12/2015 09:41:47 AM Central Daylight Time				07/16/2015 09:50:25 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage SMS (HMO)	01	01		1			H4407	011	0	2016	Southern Mississippi		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4407	025	1	1	01	01	H4407_025_1	6		1	07/14/2015	2016.01	07/14/2015 03:56:13 PM Central Daylight Time	08/01/2015 09:47:15 AM Central Daylight Time	07/30/2015 08:23:16 AM Central Daylight Time			08/03/2015 03:57:29 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred SMS (HMO)	01	01		1			H4407	025	1	2016	Southern Mississippi	Mississippi Preferred	2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	025	2	1	01	01	H4407_025_2	6		1	07/14/2015	2016.01	07/14/2015 03:56:41 PM Central Daylight Time	08/01/2015 09:47:45 AM Central Daylight Time	07/30/2015 08:23:44 AM Central Daylight Time			08/03/2015 03:57:29 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred SMS (HMO)	01	01		1			H4407	025	2	2016	Southern Mississippi	Mississippi Preferred Select Counties	2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	012	0	1	01	01	H4454_012_0	3		1	07/08/2015	2016.01	07/08/2015 05:07:43 PM Central Daylight Time	07/12/2015 09:43:17 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H4454	012	0	2016	Tennessee		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4454	020	0	1	01	01	H4454_020_0	5	2	1	07/09/2015	2016.01	07/09/2015 03:23:16 PM Central Daylight Time	07/31/2015 07:44:18 PM Central Daylight Time	07/30/2015 08:24:16 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4454	020	0	2016	Middle and West Tennessee		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	028	0	1	01	01	H4454_028_0	4		1	07/31/2015	2016.01	07/31/2015 07:46:05 AM Central Daylight Time	07/31/2015 07:44:48 PM Central Daylight Time	07/30/2015 08:24:49 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	01	01		1			H4454	028	0	2016	East Tennessee		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	030	0	1	02	01	H4454_030_0	5		1	07/14/2015	2016.01	07/14/2015 04:29:10 PM Central Daylight Time	07/31/2015 07:45:16 PM Central Daylight Time	07/30/2015 08:25:18 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H4454	030	0	2016	Tennessee		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	031	0	1	01	01	H4454_031_0	4		1	07/16/2015	2016.01	07/16/2015 03:25:41 PM Central Daylight Time	07/31/2015 07:45:45 PM Central Daylight Time	07/30/2015 08:25:47 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred KNX (HMO)	01	01		1			H4454	031	0	2016	Knoxville		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	033	0	1	01	01	H4454_033_0	4		1	07/08/2015	2016.01	07/08/2015 05:08:42 PM Central Daylight Time	07/31/2015 07:46:14 PM Central Daylight Time	07/30/2015 08:26:16 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred AR (HMO)	01	01		1			H4454	033	0	2016	Arkansas		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	034	0	1	01	01	H4454_034_0	4	2	1	07/31/2015	2016.01	07/31/2015 08:23:54 AM Central Daylight Time	07/31/2015 07:46:43 PM Central Daylight Time	07/30/2015 08:26:48 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare AR (HMO SNP)	01	01		1			H4454	034	0	2016	Arkansas		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	035	0	1	01	01	H4454_035_0	4	2	1	07/31/2015	2016.01	07/31/2015 09:50:16 AM Central Daylight Time	07/31/2015 07:47:13 PM Central Daylight Time	07/30/2015 08:27:20 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare ETN (HMO SNP)	01	01		1			H4454	035	0	2016	East Tennessee		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	036	0	1	02	01	H4454_036_0	5		1	07/14/2015	2016.01	07/14/2015 04:04:20 PM Central Daylight Time	07/31/2015 07:47:41 PM Central Daylight Time	07/30/2015 08:27:49 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Plus (HMO-POS)	01	02		1			H4454	036	0	2016	Tennessee		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	037	1	1	01	01	H4454_037_1	4		1	07/14/2015	2016.01	07/14/2015 04:26:01 PM Central Daylight Time	07/31/2015 07:48:10 PM Central Daylight Time	07/30/2015 08:28:17 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4454	037	1	2016	Tennessee	Tennessee Preferred	2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	037	2	1	01	01	H4454_037_2	4		1	07/16/2015	2016.01	07/16/2015 01:23:41 PM Central Daylight Time	07/31/2015 07:48:39 PM Central Daylight Time	07/30/2015 08:28:46 AM Central Daylight Time			08/03/2015 09:16:57 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4454	037	2	2016	Tennessee	Tennessee Preferred Select Counties	2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4454	805	0	1	01	01	H4454_805_0	3		1	05/21/2015	2016.01	05/21/2015 09:30:11 PM Central Daylight Time	07/12/2015 09:48:12 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H4454	805	0	2016	Tennessee, Mississippi, Illinois		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H4454	809	0	1	02	01	H4454_809_0	3		1	05/22/2015	2016.01	05/22/2015 08:37:27 PM Central Daylight Time	07/12/2015 09:48:41 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H4454	809	0	2016	Tennessee, Mississippi, Illinois		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1	2			
H4454	810	0	1	01	01	H4454_810_0	3		1	05/21/2015	2016.01	05/21/2015 09:27:47 PM Central Daylight Time	07/12/2015 09:49:11 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H4454	810	0	2016	Tennessee, Mississippi, Illinois		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H4454	811	0	1	01	01	H4454_811_0	3		1	05/21/2015	2016.01	05/21/2015 09:27:58 PM Central Daylight Time	07/12/2015 09:50:36 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H4454	811	0	2016	Tennessee, Mississippi, Illinois		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H4454	812	0	1	02	01	H4454_812_0	3		1	05/22/2015	2016.01	05/22/2015 08:38:43 PM Central Daylight Time	07/12/2015 09:51:12 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H4454	812	0	2016	Tennessee, Mississippi, Illinois		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1	2			
H4454	813	0	1	02	01	H4454_813_0	3		1	05/21/2015	2016.01	05/21/2015 09:23:30 PM Central Daylight Time	07/12/2015 09:51:45 AM Central Daylight Time				07/16/2015 03:50:30 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H4454	813	0	2016	Tennessee, Mississippi, Illinois		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1	2			
H4461	004	0	1	01	01	H4461_004_0	2		1	07/08/2015	2016.01	07/08/2015 10:09:58 AM Eastern Daylight Time	05/24/2015 07:18:34 PM Eastern Daylight Time				07/10/2015 02:22:30 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-004 (HMO)	01	01		1			H4461	004	0	2016	East Tennessee		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(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	2	1	07/31/2015	2016.01	07/31/2015 09:32:14 AM Eastern Daylight Time	08/03/2015 12:35:36 PM Eastern Daylight Time	07/30/2015 12:01:42 PM Eastern Daylight Time			08/04/2015 02:03:50 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4461-022 (HMO SNP)	01	01		1			H4461	022	0	2016	Greater Tennessee		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	025	0	1	01	01	H4461_025_0	3		1	07/08/2015	2016.01	07/08/2015 10:10:49 AM Eastern Daylight Time	08/01/2015 09:58:36 AM Eastern Daylight Time	07/30/2015 12:02:20 PM Eastern Daylight Time			08/04/2015 02:03:50 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-025 (HMO)	01	01		1			H4461	025	0	2016	Memphis Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	029	0	1	01	01	H4461_029_0	3		1	07/08/2015	2016.01	07/08/2015 10:11:12 AM Eastern Daylight Time	08/01/2015 09:59:17 AM Eastern Daylight Time	07/29/2015 11:11:56 PM Eastern Daylight Time			08/04/2015 02:03:50 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-029 (HMO)	01	01		1			H4461	029	0	2016	Nashville Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/09/2015	2016.01	07/09/2015 01:41:29 PM Eastern Daylight Time	08/01/2015 09:59:57 AM Eastern Daylight Time	07/30/2015 12:02:56 PM Eastern Daylight Time			08/04/2015 02:03:50 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	1	2016	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	030	2	1	01	01	H4461_030_2	3		1	07/09/2015	2016.01	07/09/2015 01:41:47 PM Eastern Daylight Time	08/01/2015 10:00:19 AM Eastern Daylight Time	07/30/2015 12:03:32 PM Eastern Daylight Time			08/04/2015 02:03:50 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	2	2016	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	030	3	1	01	01	H4461_030_3	3		1	07/09/2015	2016.01	07/09/2015 01:42:06 PM Eastern Daylight Time	08/01/2015 10:00:39 AM Eastern Daylight Time	07/30/2015 12:04:08 PM Eastern Daylight Time			08/04/2015 02:03:50 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	3	2016	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	031	1	1	01	01	H4461_031_1	3		1	07/08/2015	2016.01	07/08/2015 03:35:44 PM Eastern Daylight Time	08/01/2015 10:00:58 AM Eastern Daylight Time	07/30/2015 12:04:44 PM Eastern Daylight Time			08/04/2015 02:03:50 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	1	2016	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 03:40:05 PM Eastern Daylight Time	08/01/2015 10:01:18 AM Eastern Daylight Time	07/30/2015 12:05:20 PM Eastern Daylight Time			08/04/2015 02:03:50 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	2	2016	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	031	3	1	01	01	H4461_031_3	3		1	07/08/2015	2016.01	07/08/2015 03:44:26 PM Eastern Daylight Time	08/01/2015 10:01:39 AM Eastern Daylight Time	07/30/2015 12:05:58 PM Eastern Daylight Time			08/04/2015 02:03:50 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	3	2016	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/11/2015	2016.01	05/11/2015 02:34:12 PM Eastern Daylight Time	05/29/2015 08:18:22 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4461	806	0	2016	Select counties in East Tennessee area		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4461	807	0	1	01	01	H4461_807_0	1		1	05/11/2015	2016.01	05/11/2015 02:35:18 PM Eastern Daylight Time	05/29/2015 08:18:50 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4461	807	0	2016	Select counties in East Tennessee area		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4465	001	0	1	48	05	H4465_001_0	4		1	08/11/2015	2016.01	08/11/2015 09:48:27 AM Eastern Daylight Time					08/11/2015 09:50:40 AM Eastern Daylight Time	INDEPENDENCE CARE SYSTEM, INC.	ICS Community Care Plus FIDA MMP	www.icsny.org	ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)	05	48		1			H4465	001	0	2016	Manhattan, Kings, Bronx, Queens Counties		2	2015	2			2							http://www.icsny.org/sitemanagement/wp-content/uploads/2014/12/Provider_Pharmacy_Directory_FINAL_12.	http://www.icsny.org/sitemanagement/wp-content/uploads/2014/11/List-of-Covered-Drugs_CA_FINAL38ea_07	http://www.icsny.org/sitemanagement/wp-content/uploads/2014/12/Provider_Pharmacy_Directory_FINAL_12.	(877)427-2525		(212)584-2500		(877)427-2525		(212)584-2500		(888)807-7542		(212)584-2500		(888)807-7542		(212)584-2500		(711)-		(646)653-6000		(711)-		(646)653-6000		(711)-		(646)653-6000		(711)-		(646)653-6000		2					2					2				
H4488	001	0	1	01	01	H4488_001_0	5		1	07/13/2015	2016.01	07/13/2015 08:33:27 AM Central Daylight Time	07/29/2015 04:16:58 PM Central Daylight Time	07/29/2015 02:07:34 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	HARVESTPLAINS HEALTH OF IOWA	HarvestPlains Health of Iowa	www.harvestplainshealth.com	Classic Plus Rx (HMO)	01	01		1			H4488	001	0	2016	Dallas, Polk and Warren Counties		2	682	2			2							www.harvestplainshealth.com	www.harvestplainshealth.com	www.harvestplainshealth.com	(855)581-4101		(855)581-4101		(855)581-4101		(855)581-4101		(855)581-4101		(855)581-4101		(855)581-4101		(855)581-4101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4490	001	0	1	01	01	H4490_001_0	6		1	08/05/2015	2016.01	08/05/2015 11:39:52 AM Eastern Daylight Time	08/05/2015 11:18:47 AM Eastern Daylight Time	08/03/2015 05:02:45 PM Eastern Daylight Time			08/05/2015 02:22:21 PM Eastern Daylight Time	MISSOURI MEDICARE SELECT, LLC.	Missouri Medicare Select (HMO SNP)	www.missourimedicareselect.com	Missouri Medicare Select (HMO SNP)	01	01		1			H4490	001	0	2016	MO Counties: CAS, JAK, LAF, SCH & SLC		2		2			1	1	1	1				www.missourimedicareselect.com	www.missourimedicareselect.com	www.missourimedicareselect.com	(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(800)676-3777		(711)-		(800)676-3777		(711)-		(800)676-3777		(711)-		(800)676-3777		(711)-		2					1					2	2			
H4497	001	1	1	04	01	H4497_001_1	10		1	07/31/2015	2016.01	07/31/2015 09:41:58 AM Eastern Daylight Time	07/30/2015 04:07:04 PM Eastern Daylight Time	07/30/2015 04:07:31 PM Eastern Daylight Time			07/31/2015 12:57:30 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	1	2016	Ohio Regions	Region 1	2	1170	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	001	2	1	04	01	H4497_001_2	8		1	07/30/2015	2016.01	07/30/2015 03:03:06 PM Eastern Daylight Time	07/30/2015 04:07:04 PM Eastern Daylight Time	07/30/2015 04:07:31 PM Eastern Daylight Time			07/31/2015 12:57:30 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Select (PPO)	01	04		1			H4497	001	2	2016	Ohio Regions	Region 2	2	138	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	1	1	04	01	H4497_002_1	11		1	07/31/2015	2016.01	07/31/2015 09:41:37 AM Eastern Daylight Time	07/30/2015 04:07:05 PM Eastern Daylight Time	07/30/2015 04:07:32 PM Eastern Daylight Time			07/31/2015 12:57:30 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	1	2016	Ohio Regions	Region 1	2	780	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	002	2	1	04	01	H4497_002_2	11		1	07/30/2015	2016.01	07/30/2015 03:04:31 PM Eastern Daylight Time	07/30/2015 04:07:05 PM Eastern Daylight Time	07/30/2015 04:07:32 PM Eastern Daylight Time			07/31/2015 12:57:30 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Preferred (PPO)	01	04		1			H4497	002	2	2016	Ohio Regions	Region 2	2	92	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	1	1	04	01	H4497_003_1	9		1	07/31/2015	2016.01	07/31/2015 09:41:21 AM Eastern Daylight Time	07/30/2015 04:07:06 PM Eastern Daylight Time	07/30/2015 04:07:32 PM Eastern Daylight Time			07/31/2015 12:57:30 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	1	2016	Ohio Regions	Region 1	2	2340	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	003	2	1	04	01	H4497_003_2	9		1	07/30/2015	2016.01	07/30/2015 03:05:32 PM Eastern Daylight Time	07/30/2015 04:07:07 PM Eastern Daylight Time	07/30/2015 04:07:32 PM Eastern Daylight Time			07/31/2015 12:57:30 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Premium (PPO)	01	04		1			H4497	003	2	2016	Ohio Regions	Region 2	2	276	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	801	0	1	04	01	H4497_801_0	1		1	05/21/2015	2016.01	05/21/2015 02:51:45 PM Eastern Daylight Time	05/28/2015 11:38:36 PM Eastern Daylight Time				05/29/2015 01:13:19 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (Calendar Year) (PPO)	01	04		1			H4497	801	0	2016	Ohio Regions		1	50	2			2							medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;8b1;8b2;9a;9b;10a;11a;11b;	2		1						2			
H4497	802	0	1	04	01	H4497_802_0	1		1	05/21/2015	2016.01	05/21/2015 01:42:38 PM Eastern Daylight Time	05/28/2015 11:39:00 PM Eastern Daylight Time				05/29/2015 01:13:19 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (Non-Calendar Year) (PPO)	01	04		1			H4497	802	0	2016	Ohio Regions		1	50	2			2							medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;8b1;9a;9b;10a;11a;11b;	2		1						2			
H4497	803	0	1	04	01	H4497_803_0	1		1	05/21/2015	2016.01	05/21/2015 01:44:22 PM Eastern Daylight Time	05/28/2015 11:39:26 PM Eastern Daylight Time				05/29/2015 01:13:19 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (MA-Only) (PPO)	01	04		1			H4497	803	0	2016	Ohio Regions		1	50	2			2							medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;8a;8b1;9a;9b;10a;11a;11b;	2		1						2			
H4506	003	0	1	01	01	H4506_003_0	8		1	07/14/2015	2016.01	07/14/2015 03:16:09 PM Central Daylight Time	08/03/2015 12:30:46 PM Central Daylight Time	07/31/2015 03:26:12 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	TexanPlus Classic (HMO)	01	01		1			H4506	003	0	2016	Houston/Beaumont Area		2		2			2							www.TexanPlus.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4506	010	0	1	01	01	H4506_010_0	6		1	07/14/2015	2016.01	07/14/2015 03:17:35 PM Central Daylight Time	06/23/2015 11:50:34 AM Central Daylight Time				07/14/2015 03:29:13 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	TexanPlus Value (HMO)	01	01		1			H4506	010	0	2016	Houston/Beaumont Area		2		2			2							www.TexanPlus.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4506	029	0	1	02	01	H4506_029_0	6		1	07/13/2015	2016.01	07/13/2015 04:07:19 PM Central Daylight Time	08/03/2015 12:40:09 PM Central Daylight Time	07/31/2015 03:26:44 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlusPOS.com	TexanPlus Choice (HMO-POS)	01	02		1			H4506	029	0	2016	Houston/Beaumont Area		2		2			2							www.TexanPlusPOS.com	www.TexanPlusPOS.com	www.TexanPlusPOS.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4506	801	0	1	01	01	H4506_801_0	5		1	05/30/2015	2016.01	05/30/2015 12:19:35 PM Central Daylight Time	06/24/2015 12:23:37 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	H4506 - Retiree - MA-PD non-CY (HMO)	01	01		1			H4506	801	0	2016	TexanPlus-Employer Group (MAPD nonCY)		1		2			2							www.Universal-American-Medicare.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4506	806	0	1	01	01	H4506_806_0	5		1	05/30/2015	2016.01	05/30/2015 12:20:17 PM Central Daylight Time	06/24/2015 12:32:01 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	H4506 - Retiree - MA-PD CY (HMO)	01	01		1			H4506	806	0	2016	TexanPlus-Employer Group (MAPD CY)		1		2			2							www.Universal-American-Medicare.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4506	808	0	1	01	01	H4506_808_0	5		1	05/30/2015	2016.01	05/30/2015 12:20:51 PM Central Daylight Time	06/24/2015 12:40:11 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	H4506 - Retiree MA (HMO)	01	01		1			H4506	808	0	2016	TexanValue-Employer Group (MA Only)		1		2			2							www.Universal-American-Medicare.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H4513	009	0	1	01	01	H4513_009_0	3		1	07/15/2015	2016.01	07/15/2015 10:54:07 AM Central Daylight Time	07/10/2015 09:52:07 PM Central Daylight Time				07/16/2015 03:40:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H4513	009	0	2016	Texas HealthSpring Counties		2		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	010	0	1	01	01	H4513_010_0	4	2	1	07/31/2015	2016.01	07/31/2015 07:42:36 AM Central Daylight Time	07/31/2015 09:09:46 AM Central Daylight Time	07/30/2015 08:29:20 AM Central Daylight Time			08/03/2015 09:24:52 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4513	010	0	2016	Texas HealthSpring Counties		2		2			1	3		1	2				www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	025	0	1	01	01	H4513_025_0	4		1	07/14/2015	2016.01	07/14/2015 04:30:19 PM Central Daylight Time	07/31/2015 09:10:15 AM Central Daylight Time	07/30/2015 08:29:48 AM Central Daylight Time			08/03/2015 09:24:52 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	025	0	2016	Texas		2		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	804	0	1	01	01	H4513_804_0	3		1	05/29/2015	2016.01	05/29/2015 10:40:49 AM Central Daylight Time	07/12/2015 09:53:01 AM Central Daylight Time				07/16/2015 03:40:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H4513	804	0	2016	Texas		1		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H4513	808	0	1	02	01	H4513_808_0	3		1	05/29/2015	2016.01	05/29/2015 10:42:59 AM Central Daylight Time	07/12/2015 09:53:32 AM Central Daylight Time				07/16/2015 03:40:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H4513	808	0	2016	Texas		1		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H4513	809	0	1	01	01	H4513_809_0	3		1	05/29/2015	2016.01	05/29/2015 10:40:32 AM Central Daylight Time	07/10/2015 10:03:19 PM Central Daylight Time				07/16/2015 03:40:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H4513	809	0	2016	Texas		1		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H4513	810	0	1	01	01	H4513_810_0	3		1	05/29/2015	2016.01	05/29/2015 10:41:27 AM Central Daylight Time	07/12/2015 09:54:03 AM Central Daylight Time				07/16/2015 03:40:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H4513	810	0	2016	Texas		1		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H4513	811	0	1	02	01	H4513_811_0	3		1	05/29/2015	2016.01	05/29/2015 10:45:23 AM Central Daylight Time	07/12/2015 09:54:35 AM Central Daylight Time				07/16/2015 03:40:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H4513	811	0	2016	Texas		1		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H4513	812	0	1	02	01	H4513_812_0	3		1	05/29/2015	2016.01	05/29/2015 02:31:03 PM Central Daylight Time	07/12/2015 09:55:04 AM Central Daylight Time				07/16/2015 03:40:38 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H4513	812	0	2016	Texas		1		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H4514	001	0	1	01	01	H4514_001_0	3	2	1	07/13/2015	2016.01	07/13/2015 08:38:57 AM Central Daylight Time	07/31/2015 02:08:46 PM Central Daylight Time	07/30/2015 10:05:32 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4514	001	0	2016	Houston and Austin Metro areas		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4514	007	0	1	01	01	H4514_007_0	3		1	07/31/2015	2016.01	07/31/2015 03:01:19 PM Central Daylight Time	07/31/2015 02:09:16 PM Central Daylight Time	07/30/2015 10:05:48 AM Central Daylight Time			08/03/2015 04:43:23 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4514	007	0	2016	Houston area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4514	801	0	1	01	01	H4514_801_0	1		1	04/13/2015	2016.01	04/13/2015 02:01:21 PM Central Daylight Time	05/29/2015 03:06:29 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4514	801	0	2016	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H4514	803	0	1	01	01	H4514_803_0	1		1	04/13/2015	2016.01	04/13/2015 02:02:04 PM Central Daylight Time	05/29/2015 03:06:54 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4514	803	0	2016	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H4514	806	0	1	01	01	H4514_806_0	1		1	04/13/2015	2016.01	04/13/2015 02:02:45 PM Central Daylight Time	05/29/2015 03:07:18 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4514	806	0	2016	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H4517	001	0	1	20	08	H4517_001_0	1		1	05/18/2015	2016.01	05/18/2015 08:43:44 AM Central Daylight Time		05/15/2015 03:53:54 PM Central Daylight Time			05/18/2015 09:16:11 AM Central Daylight Time	AMARILLO MULTISVC CTR FR THE AGING INC	The basics at Jan Werner	alana@janwerneradultdaycare.org	DUAL ELIGIBLE (PACE)	08	20		1			H4517	001	0	2016	Potter, TX and Randall, TX Counties		2		2			2								N/A	N/A									(888)299-6401		(806)374-8400		(888)299-6401		(806)374-5516										(800)735-2989		(806)374-8400		(800)735-2989		(806)374-5516																
H4517	002	0	1	20	08	H4517_002_0	1		1	05/18/2015	2016.01	05/18/2015 08:44:13 AM Central Daylight Time		05/15/2015 03:55:28 PM Central Daylight Time			05/18/2015 09:16:11 AM Central Daylight Time	AMARILLO MULTISVC CTR FR THE AGING INC	The basics at Jan Werner	alana@janwerneradultdaycare.org	MEDICARE ONLY (PACE)	08	20		1			H4517	002	0	2016	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	05/15/2015	2016.01	05/15/2015 07:51:27 AM Mountain Daylight Time		05/14/2015 12:13:58 PM Mountain Daylight Time			05/15/2015 07:55:15 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	2016	El Paso, Texas and El Paso County		2		2			2								www.bienvivir.org	www.bienvivir.org									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801															
H4518	002	0	1	20	08	H4518_002_0	1		1	05/15/2015	2016.01	05/15/2015 07:52:19 AM Mountain Daylight Time		05/14/2015 12:30:12 PM Mountain Daylight Time			05/15/2015 07:55:15 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	2016	El Paso, Texas and El Paso County		2		2			2								www.bienvivir.org	www.bienvivir.org									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801															
H4523	001	0	1	01	01	H4523_001_0	10		1	08/01/2015	2016.01	08/01/2015 07:47:44 AM Central Daylight Time	08/04/2015 08:31:29 AM Central Daylight Time	07/29/2015 04:30:17 PM Central Daylight Time			08/04/2015 02:26:33 PM Central Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	001	0	2016	South Central Texas		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	005	0	1	01	01	H4523_005_0	8		1	08/01/2015	2016.01	08/01/2015 07:52:00 AM Central Daylight Time	08/04/2015 08:44:07 AM Central Daylight Time	07/29/2015 04:30:36 PM Central Daylight Time			08/04/2015 02:26:33 PM Central Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	005	0	2016	North Central Texas		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	015	0	1	01	01	H4523_015_0	8		1	08/01/2015	2016.01	08/01/2015 07:54:24 AM Central Daylight Time	08/04/2015 08:46:00 AM Central Daylight Time	07/29/2015 04:30:55 PM Central Daylight Time			08/04/2015 02:26:33 PM Central Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	015	0	2016	Southeast Texas		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	020	0	1	01	01	H4523_020_0	6		1	08/01/2015	2016.01	08/01/2015 11:02:09 AM Central Daylight Time	08/02/2015 06:27:22 PM Central Daylight Time	07/29/2015 04:31:15 PM Central Daylight Time			08/03/2015 08:14:49 AM Central Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	020	0	2016	Bexar and Comal counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	021	0	1	01	01	H4523_021_0	6		1	08/01/2015	2016.01	08/01/2015 10:44:23 AM Central Daylight Time	08/02/2015 06:28:47 PM Central Daylight Time	07/29/2015 04:31:34 PM Central Daylight Time			08/03/2015 08:14:49 AM Central Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	021	0	2016	Collin, Dallas, Denton, Parker,  Tarrant Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	024	0	1	01	01	H4523_024_0	5		1	08/01/2015	2016.01	08/01/2015 11:10:08 AM Central Daylight Time	08/02/2015 06:29:45 PM Central Daylight Time	07/29/2015 04:31:53 PM Central Daylight Time			08/03/2015 08:17:21 AM Central Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	024	0	2016	Harris, Montgomery, Fort Bend, Jefferson		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	801	0	1	01	01	H4523_801_0	4		1	05/29/2015	2016.01	05/29/2015 02:03:11 PM Central Daylight Time	07/16/2015 03:41:25 PM Central Daylight Time				07/16/2015 08:07:47 PM Central Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H4523	801	0	2016	Texas		1	64	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1	2			
H4523	802	0	1	01	01	H4523_802_0	4		1	05/29/2015	2016.01	05/29/2015 02:03:20 PM Central Daylight Time	07/16/2015 03:43:42 PM Central Daylight Time				07/16/2015 08:07:47 PM Central Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H4523	802	0	2016	Texas		1	918	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H4525	001	0	1	01	01	H4525_001_0	7		1	08/07/2015	2016.01	08/07/2015 01:39:22 PM Central Daylight Time	08/05/2015 11:26:23 AM Central Daylight Time	08/05/2015 11:26:59 AM Central Daylight Time			08/07/2015 03:23:24 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	001	0	2016	FirstCare Advantage Gold (Abilene Region)		2	277	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2	2			
H4525	002	0	1	01	01	H4525_002_0	7		1	08/07/2015	2016.01	08/07/2015 01:41:21 PM Central Daylight Time	08/05/2015 11:26:25 AM Central Daylight Time	08/05/2015 11:27:00 AM Central Daylight Time			08/07/2015 03:25:34 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	002	0	2016	FirstCare Advantage Gold (Lubbock Region)		2	1815	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2	2			
H4525	003	0	1	01	01	H4525_003_0	5	2	1	08/05/2015	2016.01	08/05/2015 11:44:44 AM Central Daylight Time	08/05/2015 11:26:26 AM Central Daylight Time	08/05/2015 11:27:01 AM Central Daylight Time			08/05/2015 12:03:14 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Select (HMO SNP)	01	01		1			H4525	003	0	2016	FirstCare Advantage Select		2	1315	2			1	3		1	2			www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					1					1	2			
H4525	004	0	1	01	01	H4525_004_0	5		1	07/06/2015	2016.01	07/06/2015 03:54:34 PM Central Daylight Time	07/20/2015 04:03:24 PM Central Daylight Time				07/20/2015 04:13:24 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	004	0	2016	FirstCare Advantage Silver (Abilene Region)		2	19	2			2							www.firstcare.com	www,firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2	2			
H4525	005	0	1	01	01	H4525_005_0	5		1	07/06/2015	2016.01	07/06/2015 03:55:15 PM Central Daylight Time	07/20/2015 04:03:20 PM Central Daylight Time				07/20/2015 04:15:01 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	005	0	2016	FirstCare Advantage Silver (Lubbock Region)		2	78	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2	2			
H4525	010	0	1	01	01	H4525_010_0	7		1	08/07/2015	2016.01	08/07/2015 01:46:16 PM Central Daylight Time	08/05/2015 11:26:19 AM Central Daylight Time	08/05/2015 11:26:57 AM Central Daylight Time			08/07/2015 03:35:08 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	010	0	2016	FirstCare Advantage Gold (Midland/Odessa Region)		2	39	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2	2			
H4525	011	0	1	01	01	H4525_011_0	4		1	07/06/2015	2016.01	07/06/2015 04:00:09 PM Central Daylight Time	07/20/2015 04:02:32 PM Central Daylight Time				07/20/2015 04:17:43 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	011	0	2016	FirstCare Advantage Silver (Midland/Odessa Region)		2	5	2			2							www,firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2	2			
H4525	012	0	1	01	01	H4525_012_0	7		1	08/07/2015	2016.01	08/07/2015 01:48:26 PM Central Daylight Time	08/05/2015 11:26:21 AM Central Daylight Time	08/05/2015 11:26:57 AM Central Daylight Time			08/07/2015 04:09:10 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	012	0	2016	FirstCare Advantage Gold (Amarillo Region)		2	77	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2	2			
H4525	013	0	1	01	01	H4525_013_0	4		1	07/06/2015	2016.01	07/06/2015 04:01:19 PM Central Daylight Time	07/20/2015 04:02:35 PM Central Daylight Time				07/20/2015 04:20:58 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	013	0	2016	FirstCare Advantage Silver (Amarillo Region)		2	8	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2	2			
H4525	014	0	1	01	01	H4525_014_0	8		1	08/07/2015	2016.01	08/07/2015 01:49:49 PM Central Daylight Time	08/05/2015 11:26:22 AM Central Daylight Time	08/05/2015 11:26:58 AM Central Daylight Time			08/07/2015 04:52:54 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	014	0	2016	FirstCare Advantage Gold (San Angelo Region)		2	12	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2	2			
H4525	015	0	1	01	01	H4525_015_0	4		1	07/06/2015	2016.01	07/06/2015 04:02:52 PM Central Daylight Time	07/20/2015 04:02:29 PM Central Daylight Time				07/20/2015 04:23:08 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	015	0	2016	FirstCare Advantage Silver (San Angelo Region)		2	5	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2	2			
H4525	802	0	1	01	01	H4525_802_0	2		1	05/26/2015	2016.01	05/26/2015 07:55:05 PM Central Daylight Time	07/20/2015 04:02:58 PM Central Daylight Time				07/20/2015 04:24:19 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Employer (D) (HMO)	01	01		1			H4525	802	0	2016	FirstCare Advantage Employer (D)		1	100	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		1	1	1a;1b;2;3-1;5;6;8b1;8b2;9a;9b;11a;11b;15;	2		1					2	2			
H4525	803	0	1	01	01	H4525_803_0	2		1	05/26/2015	2016.01	05/26/2015 07:56:07 PM Central Daylight Time	07/20/2015 04:02:59 PM Central Daylight Time				07/20/2015 04:25:23 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Employer (HMO)	01	01		1			H4525	803	0	2016	FirstCare Advantage Employer		1	100	2			2							www.firstcare.com	www,firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										1	1	1a;1b;2;3-1;5;6;8b1;8b2;9a;9b;11a;11b;15;	2		1					2	2			
H4525	804	0	1	01	01	H4525_804_0	2		1	05/26/2015	2016.01	05/26/2015 07:56:15 PM Central Daylight Time	07/20/2015 04:03:00 PM Central Daylight Time				07/20/2015 04:26:39 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Employer (D) (HMO)	01	01		1			H4525	804	0	2016	FirstCare Advantage Employer (D)		1	100	2			2							www.firstcare.com	www,firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		1	1	1a;1b;2;3-1;5;6;8b1;8b2;9a;9b;11a;11b;15;	2		1					2	2			
H4525	805	0	1	01	01	H4525_805_0	2		1	05/26/2015	2016.01	05/26/2015 07:56:21 PM Central Daylight Time	07/20/2015 04:02:57 PM Central Daylight Time				07/20/2015 04:27:46 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Employer (HMO)	01	01		1			H4525	805	0	2016	FirstCare Advantage Employer		1	100	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										1	1	1a;1b;2;3-1;5;6;8b1;8b2;9a;9b;11a;11b;15;	2		1					2	2			
H4527	001	0	1	01	01	H4527_001_0	2		1	08/03/2015	2016.01	08/03/2015 10:02:11 AM Central Daylight Time	07/31/2015 01:55:48 PM Central Daylight Time	07/30/2015 10:06:04 AM Central Daylight Time			08/03/2015 04:44:38 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	001	0	2016	Aransas, Kleberg, Nueces, San Patricio counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	002	0	1	01	01	H4527_002_0	3		1	07/31/2015	2016.01	07/31/2015 03:31:19 PM Central Daylight Time	07/31/2015 01:56:24 PM Central Daylight Time	07/30/2015 10:06:20 AM Central Daylight Time			08/03/2015 04:44:38 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	002	0	2016	Hays, Travis, and Williamson counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	003	0	1	01	01	H4527_003_0	3	2	1	07/13/2015	2016.01	07/13/2015 08:41:54 AM Central Daylight Time	07/31/2015 01:57:00 PM Central Daylight Time	07/30/2015 10:06:38 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	003	0	2016	Hays, Travis and Williamson counties		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	004	0	1	01	01	H4527_004_0	3	2	1	07/13/2015	2016.01	07/13/2015 08:42:47 AM Central Daylight Time	07/31/2015 01:57:35 PM Central Daylight Time	07/30/2015 10:06:55 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	004	0	2016	Aransas, Kleberg, Nueces, San Patricio counties		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	005	0	1	01	01	H4527_005_0	2		1	08/03/2015	2016.01	08/03/2015 02:09:32 PM Central Daylight Time	07/31/2015 01:58:12 PM Central Daylight Time	07/30/2015 10:07:13 AM Central Daylight Time			08/03/2015 04:44:38 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	005	0	2016	El Paso County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	006	0	1	01	01	H4527_006_0	3	2	1	08/03/2015	2016.01	08/03/2015 09:16:35 AM Central Daylight Time	08/03/2015 09:46:48 AM Central Daylight Time	07/31/2015 02:45:05 PM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	006	0	2016	El Paso County		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	013	0	1	01	01	H4527_013_0	2		1	08/03/2015	2016.01	08/03/2015 10:09:07 AM Central Daylight Time	07/31/2015 03:03:45 PM Central Daylight Time	07/30/2015 10:07:52 AM Central Daylight Time			08/03/2015 04:44:38 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	013	0	2016	Cameron, Hidalgo, and Willacy counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	015	0	1	01	01	H4527_015_0	3	2	1	07/13/2015	2016.01	07/13/2015 08:43:28 AM Central Daylight Time	07/31/2015 01:59:59 PM Central Daylight Time	07/30/2015 10:08:08 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	015	0	2016	Cameron, Hidalgo, and Willacy counties		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	024	0	1	01	01	H4527_024_0	2		1	05/23/2015	2016.01	05/23/2015 11:09:47 PM Central Daylight Time	05/29/2015 03:42:54 PM Central Daylight Time				07/13/2015 01:24:59 PM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus Essential (HMO)	01	01		1			H4527	024	0	2016	Select counties in Texas		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4528	001	0	1	01	01	H4528_001_0	4		1	07/08/2015	2016.01	07/08/2015 05:10:31 PM Central Daylight Time	07/31/2015 09:10:45 AM Central Daylight Time	07/30/2015 08:30:16 AM Central Daylight Time			08/03/2015 09:24:52 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4528	001	0	2016	Select Texas Counties		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4528	002	0	1	01	01	H4528_002_0	4	2	1	07/31/2015	2016.01	07/31/2015 07:43:11 AM Central Daylight Time	07/31/2015 09:11:14 AM Central Daylight Time	07/30/2015 08:30:48 AM Central Daylight Time			08/03/2015 09:24:52 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4528	002	0	2016	Select Texas Counties		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4564	001	0	1	18	06	H4564_001_0	5		1	08/06/2015	2016.01	08/06/2015 06:22:17 PM Central Daylight Time		08/10/2015 04:13:44 PM Central Daylight Time			08/11/2015 02:43:51 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Premium - Basic Rx (Cost)	06	18		1			H4564	001	0	2016	Central Texas		2	105	2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2	2			
H4564	002	0	1	18	06	H4564_002_0	10		1	07/22/2015	2016.01	07/22/2015 10:59:09 AM Central Daylight Time		08/10/2015 04:24:40 PM Central Daylight Time			08/11/2015 02:43:51 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Preferred - Basic Rx (Cost)	06	18		1			H4564	002	0	2016	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2	2			
H4564	004	0	1	18	06	H4564_004_0	3		1	07/16/2015	2016.01	07/16/2015 02:35:46 PM Central Daylight Time		06/01/2015 01:52:46 PM Central Daylight Time			07/16/2015 03:07:41 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Premium - Enhanced Rx (Cost)	06	18		1			H4564	004	0	2016	Central Texas		2	105	2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2	2			
H4564	005	0	1	18	06	H4564_005_0	6		1	07/23/2015	2016.01	07/23/2015 11:09:53 AM Central Daylight Time		06/01/2015 01:58:08 PM Central Daylight Time			07/23/2015 11:48:42 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Preferred - Enhanced Rx (Cost)	06	18		1			H4564	005	0	2016	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2	2			
H4564	010	0	1	18	06	H4564_010_0	3		1	07/16/2015	2016.01	07/16/2015 02:34:56 PM Central Daylight Time					07/17/2015 11:09:06 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Premium-Medical Only (Cost)	06	18		1			H4564	010	0	2016	Central Texas		2	106	2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366										(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989										2					2					2	2			
H4564	011	0	1	18	06	H4564_011_0	8		1	07/23/2015	2016.01	07/23/2015 11:14:37 AM Central Daylight Time					07/23/2015 11:53:51 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Preferred-Medical Only (Cost)	06	18		1			H4564	011	0	2016	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366										(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989										2					2					2	2			
H4564	012	0	1	18	06	H4564_012_0	8		1	07/22/2015	2016.01	07/22/2015 11:02:58 AM Central Daylight Time					07/22/2015 01:37:04 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Select-Medical Only (Cost)	06	18		1			H4564	012	0	2016	Central Texas		2	0	2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366										(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989										2					2					2	2			
H4564	015	0	1	18	06	H4564_015_0	11		1	09/01/2015	2016.01	09/01/2015 01:33:50 PM Central Daylight Time		08/10/2015 01:25:00 PM Central Daylight Time			09/01/2015 02:07:03 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Select - Value Rx (Cost)	06	18		1			H4564	015	0	2016	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2	2			
H4564	016	0	1	18	06	H4564_016_0	5		1	07/23/2015	2016.01	07/23/2015 11:15:39 AM Central Daylight Time					07/23/2015 11:53:51 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr VIP - Medical Only (Cost)	06	18		1			H4564	016	0	2016	Central Texas		2	106	2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366										(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989										2					2					2	2			
H4564	017	0	1	18	06	H4564_017_0	7		1	07/22/2015	2016.01	07/22/2015 10:58:25 AM Central Daylight Time		08/10/2015 04:29:10 PM Central Daylight Time			08/11/2015 02:43:51 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr VIP - Basic Rx (Cost)	06	18		1			H4564	017	0	2016	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2	2			
H4564	018	0	1	18	06	H4564_018_0	6		1	09/01/2015	2016.01	09/01/2015 01:36:53 PM Central Daylight Time		08/10/2015 02:01:06 PM Central Daylight Time			09/01/2015 02:07:03 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr VIP - Enhanced Rx (Cost)	06	18		1			H4564	018	0	2016	Central Texas		2	106	2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2	2			
H4564	801	0	1	18	06	H4564_801_0	1		1	05/22/2015	2016.01	05/22/2015 11:30:36 AM Central Daylight Time					06/01/2015 07:04:35 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare EGWP (Cost)	06	18		1			H4564	801	0	2016	Central Texas		1		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989													2			
H4590	010	0	1	01	01	H4590_010_0	7		1	07/31/2015	2016.01	07/31/2015 03:15:33 PM Central Daylight Time	07/31/2015 01:44:00 PM Central Daylight Time	07/30/2015 10:08:24 AM Central Daylight Time			08/03/2015 04:45:50 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H4590	010	0	2016	San Antonio area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	012	0	1	01	01	H4590_012_0	4		1	07/31/2015	2016.01	07/31/2015 03:16:44 PM Central Daylight Time	07/31/2015 01:44:23 PM Central Daylight Time	07/30/2015 10:08:40 AM Central Daylight Time			08/03/2015 04:45:50 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H4590	012	0	2016	Dallas/Fort Worth Metroplex		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	020	0	1	01	01	H4590_020_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:45:26 AM Central Daylight Time	07/31/2015 01:44:47 PM Central Daylight Time	07/30/2015 10:08:57 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4590	020	0	2016	Dallas and Fort Worth metro areas		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	022	0	1	01	01	H4590_022_0	3	2	1	07/13/2015	2016.01	07/13/2015 08:45:42 AM Central Daylight Time	07/31/2015 01:45:10 PM Central Daylight Time	07/30/2015 10:09:15 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4590	022	0	2016	San Antonio metro area		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	025	0	1	01	01	H4590_025_0	3		1	07/31/2015	2016.01	07/31/2015 03:17:47 PM Central Daylight Time	07/31/2015 01:45:34 PM Central Daylight Time	07/30/2015 10:09:31 AM Central Daylight Time			08/03/2015 04:45:50 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H4590	025	0	2016	Nueces and San Patricio counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	027	0	1	01	01	H4590_027_0	2		1	05/25/2015	2016.01	05/25/2015 08:23:40 PM Central Daylight Time	05/29/2015 03:45:46 PM Central Daylight Time				07/13/2015 01:24:59 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H4590	027	0	2016	Dallas/Ft Worth Metroplex		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4590	029	0	1	01	01	H4590_029_0	2		1	05/23/2015	2016.01	05/23/2015 11:20:16 PM Central Daylight Time	05/29/2015 03:46:10 PM Central Daylight Time				05/30/2015 06:23:22 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H4590	029	0	2016	San Antonio area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4590	033	0	1	01	01	H4590_033_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:46:05 AM Central Daylight Time	07/31/2015 01:45:58 PM Central Daylight Time	07/30/2015 10:09:49 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4590	033	0	2016	Corpus Christi metro area		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	037	0	1	01	01	H4590_037_0	4		1	08/03/2015	2016.01	08/03/2015 10:10:13 AM Central Daylight Time	07/31/2015 02:51:12 PM Central Daylight Time	07/30/2015 10:10:07 AM Central Daylight Time			08/03/2015 04:45:50 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO SNP)	01	01		1			H4590	037	0	2016	San Antonio area		2		2			1	4		1		00011010000000000000		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(800)555-5757		(800)555-5757		(866)846-2762		(866)846-2762		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	801	0	1	01	01	H4590_801_0	1		1	04/13/2015	2016.01	04/13/2015 02:03:59 PM Central Daylight Time	05/29/2015 03:47:23 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	801	0	2016	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H4590	803	0	1	01	01	H4590_803_0	1		1	04/13/2015	2016.01	04/13/2015 02:05:14 PM Central Daylight Time	05/29/2015 03:47:48 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	803	0	2016	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H4590	804	0	1	01	01	H4590_804_0	1		1	04/13/2015	2016.01	04/13/2015 02:06:12 PM Central Daylight Time	05/29/2015 03:48:13 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	804	0	2016	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;14e;16b;18a;	1					1	2			
H4604	003	0	1	01	01	H4604_003_0	3		1	07/31/2015	2016.01	07/31/2015 03:53:40 PM Central Daylight Time	07/31/2015 12:48:17 PM Central Daylight Time	07/30/2015 10:10:23 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H4604	003	0	2016	Select Counties in Utah		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	005	0	1	01	01	H4604_005_0	2		1	05/20/2015	2016.01	05/20/2015 07:12:45 PM Central Daylight Time	05/29/2015 03:50:07 PM Central Daylight Time				07/10/2015 05:06:11 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H4604	005	0	2016	Select Counties in Utah		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	2			
H4604	011	0	1	01	01	H4604_011_0	3		1	07/31/2015	2016.01	07/31/2015 03:54:19 PM Central Daylight Time	07/31/2015 12:48:42 PM Central Daylight Time	07/30/2015 10:10:39 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H4604	011	0	2016	Select Counties in Utah		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	801	0	1	01	01	H4604_801_0	1		1	04/13/2015	2016.01	04/13/2015 02:06:43 PM Central Daylight Time	05/29/2015 03:50:55 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	801	0	2016	Salt Lake and Surrounding Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H4604	803	0	1	01	01	H4604_803_0	1		1	05/19/2015	2016.01	05/19/2015 01:15:37 PM Central Daylight Time	05/29/2015 03:51:19 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	803	0	2016	Select Counties In UT		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H4604	805	0	1	01	01	H4604_805_0	1		1	04/13/2015	2016.01	04/13/2015 02:07:52 PM Central Daylight Time	05/29/2015 03:51:44 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	805	0	2016	Select counties in UT		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H4605	001	0	1	04	01	H4605_001_0	5		1	06/30/2015	2016.01	06/30/2015 09:40:48 AM Mountain Daylight Time	06/01/2015 03:27:16 PM Mountain Daylight Time				06/30/2015 02:56:56 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H4605	001	0	2016	Davis, Salt Lake, Utah, and Weber counties		2	1539	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4605	002	0	1	04	01	H4605_002_0	7		1	06/30/2015	2016.01	06/30/2015 09:41:33 AM Mountain Daylight Time	08/04/2015 03:02:06 PM Mountain Daylight Time	08/05/2015 04:26:15 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H4605	002	0	2016	Davis, Salt Lake, Utah, and Weber counties		2	7446	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4605	004	0	1	04	01	H4605_004_0	7		1	06/30/2015	2016.01	06/30/2015 09:42:03 AM Mountain Daylight Time	08/04/2015 03:02:48 PM Mountain Daylight Time	08/05/2015 04:26:33 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H4605	004	0	2016	Davis, Salt Lake, Utah, and Weber counties		2	7900	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4605	801	0	1	04	01	H4605_801_0	7		1	06/30/2015	2016.01	06/30/2015 09:42:34 AM Mountain Daylight Time	08/04/2015 03:03:42 PM Mountain Daylight Time				08/06/2015 11:27:01 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H4605	801	0	2016	Nationwide except territories		1	1000	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;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;12;15;	2		1						2			
H4605	802	0	1	04	01	H4605_802_0	6		1	06/09/2015	2016.01	06/09/2015 10:03:06 AM Mountain Daylight Time	08/04/2015 03:04:38 PM Mountain Daylight Time				08/06/2015 11:27:01 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H4605	802	0	2016	Nationwide except territories		1	1000	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;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;12;15;	2		1						2			
H4714	001	0	1	20	08	H4714_001_0	2		1	06/01/2015	2016.01	06/01/2015 11:45:04 AM Eastern Daylight Time		06/01/2015 11:39:49 AM Eastern Daylight Time			06/01/2015 11:52:32 AM Eastern Daylight Time	PACE OF THE SOUTHERN PIEDMONT, INC.	PACE of the Southern Piedmont, Inc.	www.pacesp.com	PACE of  the Southern Piedmont - Dual (PACE)	08	20		1			H4714	001	0	2016	PACE of  the Southern Piedmont - Dual		2		2			2								Not applicable	www.seniorscript.com									(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840																
H4714	002	0	1	20	08	H4714_002_0	2		1	06/01/2015	2016.01	06/01/2015 11:45:28 AM Eastern Daylight Time		06/01/2015 11:40:09 AM Eastern Daylight Time			06/01/2015 11:52:32 AM Eastern Daylight Time	PACE OF THE SOUTHERN PIEDMONT, INC.	PACE of the Southern Piedmont, Inc.	www.pacesp.com	PACE of  the Southern Piedmont - Medicare only (PACE)	08	20		1			H4714	002	0	2016	PACE of  the Southern Piedmont - Medicare only		2		2			2								Not applicable	www.seniorscript.com									(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840																
H4738	002	0	1	04	01	H4738_002_0	3		1	05/30/2015	2016.01	05/30/2015 02:58:13 PM Eastern Daylight Time	08/04/2015 12:36:05 PM Eastern Daylight Time	08/04/2015 09:27:42 AM Eastern Daylight Time			08/04/2015 08:00:24 PM Eastern Daylight Time	AMERICA'S 1ST CHOICE HEALTH PLANS, INC.	America's 1st Choice Health Plans, Inc.	www.Americas1stChoice.com	Ambassador Plus (PPO)	01	04		1			H4738	002	0	2016	Select Counties in SC		2	0	2			2							www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(866)321-3947		(803)748-4533		(866)321-3947		(803)748-4533		(866)321-3947		(803)748-4533		(866)321-3947		(803)748-4533		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4754	004	0	1	04	01	H4754_004_0	11		1	07/16/2015	2016.01	07/16/2015 03:13:24 PM Central Daylight Time	08/03/2015 11:23:38 AM Central Daylight Time	07/29/2015 05:38:31 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 4 (PPO)	01	04		1			H4754	004	0	2016	Lane County		2	1170	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	006	0	1	04	01	H4754_006_0	9		1	07/16/2015	2016.01	07/16/2015 03:10:09 PM Central Daylight Time	05/30/2015 07:38:06 PM Central Daylight Time				07/16/2015 06:28:43 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 6 (PPO)	01	04		1			H4754	006	0	2016	Southwestern Idaho		2	1179	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	9		1	07/16/2015	2016.01	07/16/2015 03:11:43 PM Central Daylight Time	08/03/2015 11:24:38 AM Central Daylight Time	07/29/2015 05:38:18 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 7 (PPO)	01	04		1			H4754	007	0	2016	Southwestern Oregon		2	407	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	8		1	07/16/2015	2016.01	07/16/2015 03:17:26 PM Central Daylight Time	06/01/2015 04:04:40 PM Central Daylight Time				07/16/2015 06:28:43 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 8 (PPO)	01	04		1			H4754	008	0	2016	Southwestern Oregon		2	238	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	9		1	07/16/2015	2016.01	07/16/2015 03:28:18 PM Central Daylight Time	08/03/2015 11:25:36 AM Central Daylight Time	07/29/2015 05:37:57 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 9 (PPO)	01	04		1			H4754	009	0	2016	Eastern Idaho		2	3177	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	010	0	1	04	01	H4754_010_0	8		1	07/16/2015	2016.01	07/16/2015 03:24:28 PM Central Daylight Time	05/30/2015 07:42:06 PM Central Daylight Time				07/16/2015 06:28:43 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 10 (PPO)	01	04		1			H4754	010	0	2016	Eastern Idaho		2	227	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	011	0	1	04	01	H4754_011_0	8		1	07/16/2015	2016.01	07/16/2015 03:27:08 PM Central Daylight Time	08/03/2015 11:26:38 AM Central Daylight Time	07/29/2015 05:41:38 PM Central Daylight Time			08/04/2015 12:16:05 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 11 (PPO)	01	04		1			H4754	011	0	2016	Northern Idaho		2	3151	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(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	8		1	07/16/2015	2016.01	07/16/2015 03:30:59 PM Central Daylight Time	06/01/2015 04:04:40 PM Central Daylight Time				07/16/2015 06:28:43 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 12 (PPO)	01	04		1			H4754	012	0	2016	Northern Idaho		2	438	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H4754	801	0	1	04	01	H4754_801_0	6		1	05/31/2015	2016.01	05/31/2015 12:03:25 PM Central Daylight Time	05/31/2015 11:32:04 AM Central Daylight Time				05/31/2015 02:17:59 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 801 (PPO)	01	04		1			H4754	801	0	2016	Statewide - Oregon and Idaho		1	100	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;15;	2		1						2			
H4754	802	0	1	04	01	H4754_802_0	6		1	05/31/2015	2016.01	05/31/2015 01:12:33 PM Central Daylight Time	05/31/2015 11:32:04 AM Central Daylight Time				05/31/2015 02:17:59 PM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 802 (PPO)	01	04		1			H4754	802	0	2016	Statewide - Oregon and Idaho		1	100	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		1	1	1a;1b;2;5;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a;9b;10a;11a;11b;15;	2		1						2			
H4866	002	0	1	01	01	H4866_002_0	4		1	08/04/2015	2016.01	08/04/2015 03:15:11 PM Central Daylight Time	08/04/2015 04:18:04 PM Central Daylight Time	08/04/2015 04:20:39 PM Central Daylight Time			08/05/2015 12:22:37 PM Central Daylight Time	CUATRO LLC	Access Medicare	www.accessmedicareny.com	Access Medicare Platinum (HMO)	01	01		1			H4866	002	0	2016	Access Medicare -Manhattan, Bronx, Queens Counties		2	2417	1	1		2							www.accessmedicareny.com	www.accessmedicareny.com	www.accessmedicareny.com	(877)696-1121		(646)216-3050		(877)696-1116		(646)216-3050		(877)391-1120		(646)216-3050		(877)696-1116		(646)216-3050		(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			
H4866	003	0	1	01	01	H4866_003_0	5		1	08/05/2015	2016.01	08/05/2015 09:50:05 AM Central Daylight Time	08/05/2015 09:09:44 AM Central Daylight Time	08/04/2015 04:21:02 PM Central Daylight Time			08/05/2015 12:22:37 PM Central Daylight Time	CUATRO LLC	Access Medicare	www.accessmedicareny.com	Access Medicare Gold (HMO)	01	01		1			H4866	003	0	2016	Access Medicare-Manhattan, Bronx, Queens Counties		2	1139	2			2							www.accessmedicareny.com	www.accessmedicareny.com	www.accessmedicareny.com	(877)696-1121		(646)216-3050		(877)696-1116		(646)216-3050		(877)391-1120		(646)216-3050		(877)696-1116		(646)216-3050		(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			
H4866	005	0	1	01	01	H4866_005_0	7	2	1	08/11/2015	2016.01	08/11/2015 06:42:37 PM Central Daylight Time	08/04/2015 04:19:09 PM Central Daylight Time	08/04/2015 04:21:26 PM Central Daylight Time			08/11/2015 06:46:49 PM Central Daylight Time	CUATRO LLC	Access Medicare	www.accessmedicareny.com	Access Medicare Pearl (HMO SNP)	01	01		1			H4866	005	0	2016	Access Medicare-Manhattan, Bronx, Queens Counties		2	1611	1	1		1	3		1	3		1	www.accessmedicareny.com	www.accessmedicareny.com	www.accessmedicareny.com	(877)696-1121		(646)216-3050		(877)696-1116		(646)216-3050		(877)391-1120		(646)216-3050		(877)696-1116		(646)216-3050		(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			
H4866	007	0	1	01	01	H4866_007_0	5		1	08/04/2015	2016.01	08/04/2015 03:23:46 PM Central Daylight Time	08/04/2015 04:19:42 PM Central Daylight Time	08/04/2015 04:21:50 PM Central Daylight Time			08/05/2015 12:22:37 PM Central Daylight Time	CUATRO LLC	Access Medicare	www.accessmedicareny.com	Access Medicare Platinum Advantage (HMO)	01	01		1			H4866	007	0	2016	Bronx, New York, Queens Counties		2		2			2							www.accessmedicareny.com	www.accessmedicareny.com	www.accessmedicareny.com	(877)696-1121		(646)216-3050		(877)696-1116		(646)216-3050		(877)696-1120		(646)216-3050		(877)696-1120		(646)216-3050		(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			
H4866	008	0	1	01	01	H4866_008_0	8	2	1	08/11/2015	2016.01	08/11/2015 09:04:33 AM Central Daylight Time	08/05/2015 11:00:33 AM Central Daylight Time	08/04/2015 04:22:14 PM Central Daylight Time			08/11/2015 06:46:49 PM Central Daylight Time	CUATRO LLC	Access Medicare	www.accessmedicareny.com	Access Medicare Pearl Advantage (HMO SNP)	01	01		1			H4866	008	0	2016	Bronx, New York, Queens Counties		2		2			1	3		1	3		2	www.accessmedicareny.com	www.accessmedicareny.com	www.accessmedicareny.com	(877)696-1121		(646)216-3050		(877)696-1116		(646)216-3050		(877)696-1120		(646)216-3050		(877)696-1121		(646)216-3050		(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			
H4875	016	1	1	04	01	H4875_016_1	5		1	07/17/2015	2016.01	07/17/2015 03:43:37 PM Eastern Daylight Time	07/30/2015 06:00:28 PM Eastern Daylight Time	07/31/2015 11:00:36 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	1	2016	68 lower peninsula Michigan counties	Region 3	2	2332	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	2	1	04	01	H4875_016_2	5		1	07/16/2015	2016.01	07/16/2015 05:47:22 PM Eastern Daylight Time	07/30/2015 06:01:02 PM Eastern Daylight Time	07/31/2015 11:01:02 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	2	2016	68 lower peninsula Michigan counties	Region 4	2	1399	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	3	1	04	01	H4875_016_3	5		1	07/16/2015	2016.01	07/16/2015 05:47:39 PM Eastern Daylight Time	07/30/2015 06:01:34 PM Eastern Daylight Time	07/31/2015 11:01:26 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	3	2016	68 lower peninsula Michigan counties	Region 5	2	1854	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	4	1	04	01	H4875_016_4	5		1	07/16/2015	2016.01	07/16/2015 05:48:08 PM Eastern Daylight Time	07/30/2015 06:02:08 PM Eastern Daylight Time	07/31/2015 11:01:52 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	4	2016	68 lower peninsula Michigan counties	Region 1	2	6844	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	016	5	1	04	01	H4875_016_5	5		1	07/16/2015	2016.01	07/16/2015 05:48:26 PM Eastern Daylight Time	07/30/2015 06:02:40 PM Eastern Daylight Time	07/31/2015 11:02:16 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	5	2016	68 lower peninsula Michigan counties	Region 2	2	5372	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	1	1	04	01	H4875_017_1	5		1	07/16/2015	2016.01	07/16/2015 05:43:04 PM Eastern Daylight Time	07/30/2015 06:03:14 PM Eastern Daylight Time	07/31/2015 11:02:42 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	1	2016	68 lower peninsula Michigan counties	Region 1	2	2145	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	2	1	04	01	H4875_017_2	5		1	07/16/2015	2016.01	07/16/2015 05:43:48 PM Eastern Daylight Time	07/30/2015 06:03:46 PM Eastern Daylight Time	07/31/2015 11:03:06 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	2	2016	68 lower peninsula Michigan counties	Region 2	2	1210	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	3	1	04	01	H4875_017_3	5		1	07/16/2015	2016.01	07/16/2015 05:44:06 PM Eastern Daylight Time	07/30/2015 06:04:18 PM Eastern Daylight Time	07/31/2015 11:03:32 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	3	2016	68 lower peninsula Michigan counties	Region 3	2	707	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	4	1	04	01	H4875_017_4	5		1	07/16/2015	2016.01	07/16/2015 05:44:21 PM Eastern Daylight Time	07/30/2015 06:04:52 PM Eastern Daylight Time	07/31/2015 11:03:56 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	4	2016	68 lower peninsula Michigan counties	Region 4	2	365	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	017	5	1	04	01	H4875_017_5	5		1	07/16/2015	2016.01	07/16/2015 05:44:41 PM Eastern Daylight Time	07/30/2015 06:05:24 PM Eastern Daylight Time	07/31/2015 11:04:22 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	5	2016	68 lower peninsula Michigan counties	Region 5	2	487	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	1	1	04	01	H4875_018_1	6		1	07/16/2015	2016.01	07/16/2015 05:44:50 PM Eastern Daylight Time	07/30/2015 06:05:58 PM Eastern Daylight Time	07/31/2015 11:04:46 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	1	2016	68 lower peninsula Michigan counties	Region 1	2	249	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	2	1	04	01	H4875_018_2	5		1	07/16/2015	2016.01	07/16/2015 05:32:29 PM Eastern Daylight Time	07/30/2015 06:06:32 PM Eastern Daylight Time	07/31/2015 11:05:12 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	2	2016	68 lower peninsula Michigan counties	Region 2	2	1178	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	3	1	04	01	H4875_018_3	5		1	07/16/2015	2016.01	07/16/2015 05:32:41 PM Eastern Daylight Time	07/30/2015 06:07:04 PM Eastern Daylight Time	07/31/2015 11:05:38 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	3	2016	68 lower peninsula Michigan counties	Region 3	2	1113	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	4	1	04	01	H4875_018_4	5		1	07/16/2015	2016.01	07/16/2015 05:33:19 PM Eastern Daylight Time	07/30/2015 06:07:38 PM Eastern Daylight Time	07/31/2015 11:06:02 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	4	2016	68 lower peninsula Michigan counties	Region 4	2	1063	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	018	5	1	04	01	H4875_018_5	5		1	07/16/2015	2016.01	07/16/2015 05:33:32 PM Eastern Daylight Time	07/30/2015 06:08:12 PM Eastern Daylight Time	07/31/2015 11:06:28 AM Eastern Daylight Time			08/04/2015 04:06:45 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	5	2016	68 lower peninsula Michigan counties	Region 5	2	1733	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(888)389-6648		(616)464-8820		(877)438-1397		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	803	0	1	04	01	H4875_803_0	5		1	05/29/2015	2016.01	05/29/2015 10:19:00 AM Eastern Daylight Time	07/13/2015 05:55:04 PM Eastern Daylight Time				07/17/2015 03:44:16 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select EG Non-Calendar Year (PPO)	01	04		1			H4875	803	0	2016	National		1	4	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	804	0	1	04	01	H4875_804_0	5		1	05/29/2015	2016.01	05/29/2015 10:19:52 AM Eastern Daylight Time	07/13/2015 05:57:20 PM Eastern Daylight Time				07/17/2015 03:44:16 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select EG Calendar Year (PPO)	01	04		1			H4875	804	0	2016	National		1	4	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4876	001	0	1	04	01	H4876_001_0	7		1	09/11/2015	2016.01	09/11/2015 02:28:48 PM Eastern Daylight Time	08/05/2015 04:31:01 PM Eastern Daylight Time	08/05/2015 04:31:38 PM Eastern Daylight Time			09/11/2015 02:34:25 PM Eastern Daylight Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Olympus - Constellation Health (PPO)	01	04		1			H4876	001	0	2016	Puerto Rico		2	645	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2						2			
H4876	801	0	1	04	01	H4876_801_0	4		1	05/31/2015	2016.01	05/31/2015 10:06:15 PM Eastern Daylight Time	06/01/2015 06:43:25 PM Eastern Daylight Time				06/01/2015 09:48:42 PM Eastern Daylight Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Geminis 1 - Constellation Health (PPO)	01	04		1			H4876	801	0	2016	Puerto Rico		1	750	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		1	1	1a;1b;2;8a;8b1;8b2;8b3;11a;11b;	2		1						2			
H4876	802	0	1	04	01	H4876_802_0	4		1	05/22/2015	2016.01	05/22/2015 06:31:49 PM Eastern Daylight Time	06/01/2015 06:44:23 PM Eastern Daylight Time				06/01/2015 09:48:42 PM Eastern Daylight Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Geminis 2 - Constellation Health (PPO)	01	04		1			H4876	802	0	2016	Puerto Rico		1	1150	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		1	1	1a;1b;8a;8b1;8b2;8b3;9a;9b;11a;11b;	2		2						2			
H4909	014	0	1	04	01	H4909_014_0	10		1	07/20/2015	2016.01	07/20/2015 09:13:24 AM Pacific Daylight Time	08/01/2015 06:34:32 PM Pacific Daylight Time	07/30/2015 03:37:02 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	ANTHEM HEALTH PLANS OF VIRGINIA, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H4909	014	0	2016	Mathews County		2	65	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)827-9866		(866)827-9866		(800)797-5937		(800)797-5937		(866)827-9866		(866)827-9866		(844)364-2119		(844)364-2119		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	804	0	1	04	01	H4909_804_0	4		1	05/29/2015	2016.01	05/29/2015 12:26:38 PM Pacific Daylight Time	05/31/2015 09:38:53 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF VIRGINIA, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	804	0	2016	Virginia		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H4909	805	0	1	04	01	H4909_805_0	4		1	05/29/2015	2016.01	05/29/2015 12:26:47 PM Pacific Daylight Time	05/31/2015 01:16:57 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF VIRGINIA, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	805	0	2016	Virginia		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H4909	806	0	1	04	01	H4909_806_0	4		1	05/29/2015	2016.01	05/29/2015 12:25:41 PM Pacific Daylight Time	05/31/2015 01:17:02 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF VIRGINIA, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	806	0	2016	Virginia		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H4922	001	0	1	01	01	H4922_001_0	7		1	08/04/2015	2016.01	08/04/2015 04:41:58 PM Eastern Daylight Time	08/05/2015 02:39:13 PM Eastern Daylight Time	08/05/2015 02:39:13 PM Eastern Daylight Time			08/05/2015 03:07:03 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York LiveWell (HMO)	01	01		1			H4922	001	0	2016	New York City Metro Area, Long Island, Westchester		2	957	2			2							www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H4922	002	0	1	01	01	H4922_002_0	7	2	1	08/04/2015	2016.01	08/04/2015 04:26:29 PM Eastern Daylight Time	08/05/2015 02:39:15 PM Eastern Daylight Time	08/05/2015 02:39:15 PM Eastern Daylight Time			08/05/2015 03:07:03 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York BeWell (HMO SNP)	01	01		1			H4922	002	0	2016	New York City Metro Area, Long Island, Westchester		2	205	2			1	3		1	2			www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H4922	003	0	1	01	01	H4922_003_0	7	2	1	08/04/2015	2016.01	08/04/2015 04:28:05 PM Eastern Daylight Time	08/05/2015 02:39:16 PM Eastern Daylight Time	08/05/2015 02:39:16 PM Eastern Daylight Time			08/05/2015 03:07:03 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York FeelWell (HMO SNP)	01	01		1			H4922	003	0	2016	New York City Metro Area, Long Island, Westchester		2	384	2			1	3		1	5			www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(844)782-7670		(844)782-7670		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4922	004	0	1	01	01	H4922_004_0	7		1	08/04/2015	2016.01	08/04/2015 04:31:51 PM Eastern Daylight Time	08/05/2015 02:39:17 PM Eastern Daylight Time	08/05/2015 02:39:17 PM Eastern Daylight Time			08/05/2015 03:07:03 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York CareWell (HMO SNP)	01	01		1			H4922	004	0	2016	New York City Metro Area, Long Island, Westchester		2	143	2			1	1	1	1				www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2	2			
H4931	001	0	1	01	01	H4931_001_0	7	2	1	08/04/2015	2016.01	08/04/2015 01:13:43 PM US Mountain Standard Time	08/04/2015 04:23:38 PM US Mountain Standard Time	08/04/2015 04:23:39 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	001	0	2016	Cochise County		2	657	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	002	0	1	01	01	H4931_002_0	6	2	1	08/04/2015	2016.01	08/04/2015 01:19:34 PM US Mountain Standard Time	08/04/2015 04:23:39 PM US Mountain Standard Time	08/04/2015 04:23:40 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	002	0	2016	Gila County		2	148	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	003	0	1	01	01	H4931_003_0	6	2	1	08/04/2015	2016.01	08/04/2015 01:21:22 PM US Mountain Standard Time	08/04/2015 04:23:40 PM US Mountain Standard Time	08/04/2015 04:23:41 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	003	0	2016	Graham County		2	45	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	004	0	1	01	01	H4931_004_0	6	2	1	08/04/2015	2016.01	08/04/2015 01:23:19 PM US Mountain Standard Time	08/04/2015 04:23:41 PM US Mountain Standard Time	08/04/2015 04:23:42 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	004	0	2016	Greenlee County		2	8	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	005	0	1	01	01	H4931_005_0	6	2	1	08/04/2015	2016.01	08/04/2015 01:25:43 PM US Mountain Standard Time	08/04/2015 04:23:42 PM US Mountain Standard Time	08/04/2015 04:23:43 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	005	0	2016	La Paz County		2	46	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	006	0	1	01	01	H4931_006_0	6	2	1	08/04/2015	2016.01	08/04/2015 01:27:49 PM US Mountain Standard Time	08/04/2015 04:23:43 PM US Mountain Standard Time	08/04/2015 04:23:44 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	006	0	2016	Pima County		2	1897	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	007	0	1	01	01	H4931_007_0	6	2	1	08/04/2015	2016.01	08/04/2015 01:29:07 PM US Mountain Standard Time	08/04/2015 04:23:44 PM US Mountain Standard Time	08/04/2015 04:23:45 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	007	0	2016	Pinal County		2	940	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	008	0	1	01	01	H4931_008_0	6	2	1	08/04/2015	2016.01	08/04/2015 01:30:28 PM US Mountain Standard Time	08/04/2015 04:23:46 PM US Mountain Standard Time	08/04/2015 04:23:46 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	008	0	2016	Santa Cruz County		2	373	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	009	0	1	01	01	H4931_009_0	6	2	1	08/04/2015	2016.01	08/04/2015 01:33:41 PM US Mountain Standard Time	08/04/2015 04:23:47 PM US Mountain Standard Time	08/04/2015 04:23:47 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	009	0	2016	Yavapai County		2	515	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	010	0	1	01	01	H4931_010_0	6	2	1	08/04/2015	2016.01	08/04/2015 01:35:53 PM US Mountain Standard Time	08/04/2015 04:23:47 PM US Mountain Standard Time	08/04/2015 04:23:48 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.UAHealthPlans.com	University Care Advantage (HMO SNP)	01	01		1			H4931	010	0	2016	Yuma County		2	373	2			1	3		1	4			http://www.UAHealthPlans.com/UCA/ProviderSearch	http://www.UAHealthPlans.com/UCA/PartD	http://www.UAHealthPlans.com/UCA/PharmacyLookup	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4999	001	0	1	20	08	H4999_001_0	1		1	05/21/2015	2016.01	05/21/2015 01:16:22 PM Eastern Daylight Time		05/21/2015 01:12:15 PM Eastern Daylight Time			05/21/2015 01:27:07 PM Eastern Daylight Time	THE LUTHERAN HOME FOR THE AGED	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	08	20		1			H4999	001	0	2016	Counties: Erie, War, Craw, Mer, Ven, McK, For, Cla		2		2			2								www.lifenwpa.org	www.lifenwpa.org									(800)456-5433		(814)456-5433		(800)456-5433		(814)456-5433										(814)456-5433		(814)456-5433		(814)456-5433		(814)456-5433																
H4999	002	0	1	20	08	H4999_002_0	1		1	05/21/2015	2016.01	05/21/2015 01:16:47 PM Eastern Daylight Time		05/21/2015 01:12:51 PM Eastern Daylight Time			05/21/2015 01:27:07 PM Eastern Daylight Time	THE LUTHERAN HOME FOR THE AGED	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	08	20		1			H4999	002	0	2016	Counties: Erie, War, Craw, Mer, Ven, McK, For, Cla		2		2			2								www.lifenwpa.org	www.lifenwpa.org									(800)456-5433		(814)456-5433		(800)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	2		1	05/28/2015	2016.01	05/28/2015 02:25:41 PM Pacific Daylight Time		05/26/2015 05:20:27 AM Pacific Daylight Time			05/28/2015 02:26:36 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	2016	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	05/28/2015	2016.01	05/28/2015 01:00:33 PM Pacific Daylight Time		05/26/2015 05:21:40 AM Pacific Daylight Time			05/28/2015 01:02:33 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	2016	Seattle - King County Washington		2		2			2								www.providence.org/longtermcare/elderplace	www.providence.org/longtermcare/elderplace									(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325										(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325																
H5008	001	0	1	01	01	H5008_001_0	2		1	05/21/2015	2016.01	05/21/2015 09:44:05 AM Central Daylight Time	07/31/2015 01:19:51 PM Central Daylight Time	07/30/2015 10:22:06 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H5008	001	0	2016	Select Counties in Washington		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	002	0	1	01	01	H5008_002_0	4	2	1	07/13/2015	2016.01	07/13/2015 08:47:11 AM Central Daylight Time	07/31/2015 01:20:26 PM Central Daylight Time	07/30/2015 10:22:25 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5008	002	0	2016	Seattle metro area and Spokane county		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	007	0	1	01	01	H5008_007_0	3		1	05/29/2015	2016.01	05/29/2015 10:49:14 AM Central Daylight Time	07/31/2015 01:21:02 PM Central Daylight Time	07/30/2015 10:22:41 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO SNP)	01	01		1			H5008	007	0	2016	Select Counties in Washington		2		2			1	1	2	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			
H5009	001	0	1	04	01	H5009_001_0	4		1	06/30/2015	2016.01	06/30/2015 09:45:24 AM Mountain Daylight Time	06/01/2015 03:28:06 PM Mountain Daylight Time				06/30/2015 02:56:56 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H5009	001	0	2016	Select Counties in Washington		2	11879	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5009	002	0	1	04	01	H5009_002_0	5		1	06/30/2015	2016.01	06/30/2015 09:45:51 AM Mountain Daylight Time	08/04/2015 03:06:14 PM Mountain Daylight Time	08/05/2015 04:26:50 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H5009	002	0	2016	Select Counties in Washington		2	11879	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5009	801	0	1	04	01	H5009_801_0	5		1	06/09/2015	2016.01	06/09/2015 10:03:28 AM Mountain Daylight Time	08/04/2015 03:07:24 PM Mountain Daylight Time				08/06/2015 11:27:01 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H5009	801	0	2016	Nationwide except territories		1	1000	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;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;12;15;	2		1						2			
H5009	802	0	1	04	01	H5009_802_0	6		1	06/09/2015	2016.01	06/09/2015 10:03:45 AM Mountain Daylight Time	08/04/2015 03:08:12 PM Mountain Daylight Time				08/06/2015 11:27:01 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H5009	802	0	2016	Nationwide except territories		1	1000	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;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;10a;11a;11b;12;15;	2		1						2			
H5010	001	0	1	04	01	H5010_001_0	5		1	06/30/2015	2016.01	06/30/2015 12:30:01 PM Mountain Daylight Time	07/07/2015 11:57:31 AM Mountain Daylight Time				07/07/2015 03:27:15 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage Basic (PPO)	01	04		1			H5010	001	0	2016	Kittitas and Spokane counties		2	916	2			2							www.asuris.com/medicare	www.asuris.com/medicare	www.asuris.com/medicare	(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5010	002	0	1	04	01	H5010_002_0	6		1	06/30/2015	2016.01	06/30/2015 12:30:28 PM Mountain Daylight Time	08/04/2015 03:09:38 PM Mountain Daylight Time	08/05/2015 04:27:08 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Classic (PPO)	01	04		1			H5010	002	0	2016	Kittitas and Spokane counties		2	100	2			2							www.asuris.com/medicare	www.asuris.com/medicare	www.asuris.com/medicare	(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5010	004	0	1	04	01	H5010_004_0	7		1	06/30/2015	2016.01	06/30/2015 12:30:53 PM Mountain Daylight Time	08/04/2015 03:10:22 PM Mountain Daylight Time	08/05/2015 04:27:28 PM Mountain Daylight Time			08/05/2015 05:21:12 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Enhanced (PPO)	01	04		1			H5010	004	0	2016	Kittitas and Spokane counties		2	100	2			2							www.asuris.com/medicare	www.asuris.com/medicare	www.asuris.com/medicare	(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5037	001	0	1	20	08	H5037_001_0	3		1	05/21/2015	2016.01	05/21/2015 01:38:53 PM Eastern Daylight Time		05/21/2015 12:11:00 PM Eastern Daylight Time			05/21/2015 01:40:34 PM Eastern Daylight Time	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	Mountain Empire PACE	www.meoc.org	Mountain Empire PACE - Dual (PACE)	08	20		1			H5037	001	0	2016	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	3		1	05/21/2015	2016.01	05/21/2015 01:39:25 PM Eastern Daylight Time		05/21/2015 12:11:00 PM Eastern Daylight Time			05/21/2015 01:40:34 PM Eastern Daylight Time	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	Mountain Empire PACE	www.meoc.org	Mountain Empire PACE  - Medicare only (PACE)	08	20		1			H5037	002	0	2016	Lee, Scott, Wise Counties and Norton City		2		2			2								www.meoc.org	www.meoc.org									(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599										(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599																
H5042	801	0	1	04	01	H5042_801_0	7		1	05/29/2015	2016.01	05/29/2015 10:10:17 AM Eastern Daylight Time	06/01/2015 04:55:08 PM Eastern Daylight Time				06/01/2015 05:30:50 PM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (PPO)	01	04		1			H5042	801	0	2016	Greater Capital Region of New York State		1	97	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(888)831-3039		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		1	1	1b;2;6;8b1;8b2;8b3;11a;	1	1a;1b;2;5;6;8b1;8b2;8b3;14d;	1						2			
H5042	802	0	1	04	01	H5042_802_0	7		1	05/14/2015	2016.01	05/14/2015 12:48:47 PM Eastern Daylight Time	06/01/2015 04:55:09 PM Eastern Daylight Time				06/01/2015 05:30:50 PM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (PPO)	01	04		1			H5042	802	0	2016	Greater Capital Region of New York State		1	3450	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(888)831-3039		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		1	1	1b;2;6;8b1;8b2;8b3;11a;	1	1a;1b;2;5;6;8b1;8b2;8b3;14d;	1						2			
H5042	803	0	1	04	01	H5042_803_0	7		1	05/30/2015	2016.01	05/30/2015 02:02:34 PM Eastern Daylight Time	06/01/2015 04:55:05 PM Eastern Daylight Time				06/01/2015 05:30:50 PM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare (PPO)	01	04		1			H5042	803	0	2016	Greater Capital Region of New York State		1	400	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000										1	1	1b;2;6;8b1;8b2;8b3;11a;	1	1a;1b;2;5;6;8b1;8b2;8b3;14d;	1						2			
H5050	001	0	1	01	01	H5050_001_0	6		1	07/15/2015	2016.01	07/15/2015 01:13:32 PM Pacific Daylight Time	05/31/2015 10:15:35 PM Pacific Daylight Time				07/15/2015 02:02:28 PM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Basic (HMO)	01	01		1			H5050	001	0	2016	Puget Sound Area and Counties: GY, TH, LE, SP		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										2					2					2	2			
H5050	004	0	1	01	01	H5050_004_0	7		1	08/05/2015	2016.01	08/05/2015 07:55:08 AM Pacific Daylight Time	08/03/2015 04:08:58 PM Pacific Daylight Time	07/31/2015 09:34:50 AM Pacific Daylight Time			08/05/2015 09:47:28 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Optimal (HMO)	01	01		1			H5050	004	0	2016	Counties: KI, PI, KP, SN, GY, LE, MA, TH		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H5050	009	0	1	01	01	H5050_009_0	7		1	07/15/2015	2016.01	07/15/2015 01:14:34 PM Pacific Daylight Time	08/03/2015 04:09:48 PM Pacific Daylight Time	07/31/2015 09:36:33 AM Pacific Daylight Time			08/05/2015 09:47:28 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Essential (HMO)	01	01		1			H5050	009	0	2016	Counties: KI, PI, KP, SN, GY, LE, MA, TH		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H5050	013	0	1	01	01	H5050_013_0	7		1	07/15/2015	2016.01	07/15/2015 01:15:36 PM Pacific Daylight Time	08/03/2015 04:10:40 PM Pacific Daylight Time	07/31/2015 09:36:10 AM Pacific Daylight Time			08/05/2015 09:47:28 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Vital (HMO)	01	01		1			H5050	013	0	2016	Counties: KI, PI, KP, SN, GY, LE, MA, TH		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H5050	017	0	1	01	01	H5050_017_0	7		1	07/15/2015	2016.01	07/15/2015 01:16:33 PM Pacific Daylight Time	08/04/2015 10:37:25 AM Pacific Daylight Time	07/31/2015 09:35:22 AM Pacific Daylight Time			08/05/2015 09:47:28 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Harbor (HMO)	01	01		1			H5050	017	0	2016	Counties: SK, SJ, IS, WM		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H5050	018	0	1	01	01	H5050_018_0	7		1	07/15/2015	2016.01	07/15/2015 01:17:08 PM Pacific Daylight Time	08/04/2015 10:38:19 AM Pacific Daylight Time	07/31/2015 09:38:02 AM Pacific Daylight Time			08/05/2015 09:47:28 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Haven (HMO)	01	01		1			H5050	018	0	2016	Counties: SK, SJ, IS, WM		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H5050	019	0	1	01	01	H5050_019_0	7		1	08/05/2015	2016.01	08/05/2015 07:54:52 AM Pacific Daylight Time	08/03/2015 04:14:41 PM Pacific Daylight Time	07/31/2015 09:37:24 AM Pacific Daylight Time			08/05/2015 09:47:28 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Columbia (HMO)	01	01		1			H5050	019	0	2016	Spokane		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H5050	021	0	1	01	01	H5050_021_0	8		1	08/07/2015	2016.01	08/07/2015 09:46:23 AM Pacific Daylight Time	08/03/2015 04:15:30 PM Pacific Daylight Time	07/31/2015 09:36:56 AM Pacific Daylight Time			08/07/2015 09:49:45 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Centennial (HMO)	01	01		1			H5050	021	0	2016	Spokane		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2	2			
H5050	801	0	1	01	01	H5050_801_0	4		1	05/31/2015	2016.01	05/31/2015 01:41:35 PM Pacific Daylight Time	05/31/2015 10:19:53 PM Pacific Daylight Time				05/31/2015 10:23:41 PM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Employer Group (HMO)	01	01		1			H5050	801	0	2016	Puget Sound Area and Counties: GY, TH, LE, SP		1		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;12;14a;15;16b;	1	1a;1b;2;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;12;14a;14d;14e;16b;	1					1	2			
H5050	802	0	1	01	01	H5050_802_0	4		1	05/31/2015	2016.01	05/31/2015 01:41:45 PM Pacific Daylight Time	05/31/2015 10:20:00 PM Pacific Daylight Time				05/31/2015 10:23:41 PM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Employer Group with Part D (HMO)	01	01		1			H5050	802	0	2016	Puget Sound Area and Counties: GY, TH, LE, SP		1		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;12;14a;15;16b;	1	1a;1b;2;5;6;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;12;14a;14d;14e;16b;	1					1	2			
H5087	001	0	1	01	01	H5087_001_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:11:54 PM Eastern Daylight Time	08/03/2015 01:51:25 PM Eastern Daylight Time	08/03/2015 03:58:12 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Freedom Plan (HMO SNP)	01	01		1			H5087	001	0	2016	Los Angeles County		2	12305	2			1	3		1	5			www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5087	002	0	1	01	01	H5087_002_0	5		1	07/10/2015	2016.01	07/10/2015 01:12:03 PM Eastern Daylight Time	08/03/2015 01:52:16 PM Eastern Daylight Time	08/03/2015 03:58:39 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Plus Plan (HMO)	01	01		1			H5087	002	0	2016	Select Counties in CA		2	6826	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5087	005	0	1	01	01	H5087_005_0	5		1	08/01/2015	2016.01	08/01/2015 09:18:36 AM Eastern Daylight Time	08/03/2015 01:53:08 PM Eastern Daylight Time	08/03/2015 03:59:06 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	005	0	2016	Los Angeles, Orange Counties		2	10380	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5087	010	0	1	01	01	H5087_010_0	6		1	08/01/2015	2016.01	08/01/2015 09:19:03 AM Eastern Daylight Time	08/03/2015 01:53:59 PM Eastern Daylight Time	08/03/2015 03:59:33 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Value Plan (HMO)	01	01		1			H5087	010	0	2016	Fresno, San Joaquin Counties		2	1469	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5087	011	0	1	01	01	H5087_011_0	6		1	08/01/2015	2016.01	08/01/2015 09:19:16 AM Eastern Daylight Time	08/03/2015 01:54:48 PM Eastern Daylight Time	08/03/2015 04:00:00 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	011	0	2016	Alameda County		2	1876	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5087	012	0	1	01	01	H5087_012_0	6		1	08/05/2015	2016.01	08/05/2015 06:30:35 AM Eastern Daylight Time	08/03/2015 01:55:40 PM Eastern Daylight Time	08/03/2015 04:00:28 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	012	0	2016	San Diego County		2	1024	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5087	014	0	1	01	01	H5087_014_0	6		1	08/05/2015	2016.01	08/05/2015 06:30:56 AM Eastern Daylight Time	08/05/2015 09:43:38 AM Eastern Daylight Time	08/03/2015 04:00:56 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	014	0	2016	Santa Clara County		2	1141	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5087	016	0	1	01	01	H5087_016_0	6		1	08/05/2015	2016.01	08/05/2015 06:30:28 AM Eastern Daylight Time	08/05/2015 09:44:28 AM Eastern Daylight Time	08/03/2015 04:01:24 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	016	0	2016	Riverside, San Bernardino Counties		2	836	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5087	017	0	1	01	01	H5087_017_0	4		1	07/10/2015	2016.01	07/10/2015 01:13:13 PM Eastern Daylight Time	08/03/2015 01:58:14 PM Eastern Daylight Time	08/03/2015 04:01:51 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Plus Plan (HMO)	01	01		1			H5087	017	0	2016	Los Angeles County		2	3311	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5087	020	0	1	01	01	H5087_020_0	4	2	1	07/10/2015	2016.01	07/10/2015 01:13:23 PM Eastern Daylight Time	08/03/2015 01:59:06 PM Eastern Daylight Time	08/03/2015 04:02:19 PM Eastern Daylight Time			08/05/2015 10:36:07 AM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Access Plan (HMO SNP)	01	01		1			H5087	020	0	2016	Fresno, San Joaquin Counties		2	332	2			1	3		1	5			www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(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			
H5106	013	0	1	04	01	H5106_013_0	9		1	08/04/2015	2016.01	08/04/2015 07:46:35 AM Eastern Daylight Time	08/03/2015 10:40:38 AM Eastern Daylight Time	07/30/2015 08:29:36 AM Eastern Daylight Time			08/04/2015 07:51:44 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Senior Solutions Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO Standard (PPO)	01	04		1			H5106	013	0	2016	West Virginia Region 1 counties		2		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H5106	027	0	1	04	01	H5106_027_0	10		1	08/04/2015	2016.01	08/04/2015 07:46:42 AM Eastern Daylight Time	08/03/2015 10:41:03 AM Eastern Daylight Time	07/30/2015 08:29:47 AM Eastern Daylight Time			08/04/2015 07:51:44 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Senior Solutions Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H5106	027	0	2016	West Virginia Region 1 counties		2		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2						2			
H5106	806	0	1	04	01	H5106_806_0	4		1	04/30/2015	2016.01	04/30/2015 02:51:50 PM Eastern Daylight Time	05/29/2015 08:27:31 AM Eastern Daylight Time				06/01/2015 11:05:12 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Senior Solutions Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO MAPD WV NON-CALENDAR (PPO)	01	04		1			H5106	806	0	2016	ALL WV COUNTIES		1		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H5106	807	0	1	04	01	H5106_807_0	4		1	04/23/2015	2016.01	04/23/2015 08:57:17 AM Eastern Daylight Time	05/29/2015 10:32:27 AM Eastern Daylight Time				06/01/2015 11:05:12 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Senior Solutions Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO MA WV (PPO)	01	04		1			H5106	807	0	2016	ALL WV COUNTIES		1		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899										(711)-		(711)-		(800)227-8210		(800)227-8210										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H5106	808	0	1	04	01	H5106_808_0	4		1	04/23/2015	2016.01	04/23/2015 08:57:53 AM Eastern Daylight Time	05/29/2015 08:28:47 AM Eastern Daylight Time				06/01/2015 11:05:12 AM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Senior Solutions Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO MAPD WV CALENDAR (PPO)	01	04		1			H5106	808	0	2016	ALL WV COUNTIES		1		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H5124	001	0	1	20	08	H5124_001_0	1		1	05/19/2015	2016.01	05/19/2015 11:08:02 AM Eastern Daylight Time		05/18/2015 02:24:39 PM Eastern Daylight Time			05/19/2015 11:12:04 AM Eastern Daylight Time	FRANCISCAN ALLIANCE, INC.	Franciscan  Senior Health & Wellness	FranciscanStFrancis.org	Franciscan Senior Health and Wellness (PACE)	08	20		1			H5124	001	0	2016	Central Indiana		2		2			2								franciscanalliance.org	carekinesis.org									(844)817-7223		(317)782-8012		(800)743-3333		(317)782-8012										(800)743-3333		(317)528-6395		(800)743-3333		(800)743-3333																
H5124	002	0	1	20	08	H5124_002_0	1		1	05/19/2015	2016.01	05/19/2015 11:10:03 AM Eastern Daylight Time		05/18/2015 02:26:23 PM Eastern Daylight Time			05/19/2015 11:12:04 AM Eastern Daylight Time	FRANCISCAN ALLIANCE, INC.	Franciscan  Senior Health & Wellness	FranciscanStFrancis.org	Franciscan Senior Health and Wellness (PACE)	08	20		1			H5124	002	0	2016	Central Indiana		2		2			2								franciscanalliance.org	carekinesis.org									(844)817-7223		(317)782-8012		(800)743-3333		(317)782-8012										(800)743-3333		(317)528-6395		(800)743-3333		(800)743-3333																
H5141	001	0	1	04	01	H5141_001_0	18		1	07/31/2015	2016.01	07/31/2015 02:15:26 PM Eastern Daylight Time	08/03/2015 06:36:11 PM Eastern Daylight Time	08/03/2015 06:36:48 PM Eastern Daylight Time			08/03/2015 06:49:31 PM Eastern Daylight Time	CAREPOINT INSURANCE COMPANY	CarePoint Health Plans	www.carepointadvantage.org	Clover Health CarePoint (PPO)	01	04		1			H5141	001	0	2016	Hudson County		2		2			2							www.carepointadvantage.org	www.carepointadvantage.org	www.carepointadvantage.org	(888)657-1207		(201)432-2133	100	(855)593-5757		(201)432-2133	100	(855)479-3657		(201)432-2133	100	(855)593-5757		(201)432-2133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	004	0	1	04	01	H5141_004_0	16		1	08/03/2015	2016.01	08/03/2015 03:20:18 PM Eastern Daylight Time	08/03/2015 06:37:46 PM Eastern Daylight Time	08/03/2015 06:38:12 PM Eastern Daylight Time			08/03/2015 06:49:31 PM Eastern Daylight Time	CAREPOINT INSURANCE COMPANY	CarePoint Health Plans	www.carepointadvantage.com	Clover Health Classic (PPO)	01	04		1			H5141	004	0	2016	NJ  - non-Hudson counties		2		2			2							www.carepointadvantage.org	www.carepointadvantage.org	www.carepointadvantage.org	(888)657-1207		(201)432-2133	100	(855)593-5757		(201)432-2133	100	(855)479-3657		(201)432-2133	100	(855)593-5757		(201)432-2133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	006	0	1	04	01	H5141_006_0	13		1	07/31/2015	2016.01	07/31/2015 02:51:58 PM Eastern Daylight Time	08/03/2015 06:38:36 PM Eastern Daylight Time	08/03/2015 06:39:14 PM Eastern Daylight Time			08/03/2015 06:49:31 PM Eastern Daylight Time	CAREPOINT INSURANCE COMPANY	CarePoint Health Plans	www.carepointadvantage.org	Clover Health Prestige (PPO)	01	04		1			H5141	006	0	2016	Counties: BER, ESX, HUD, MON, SOM, UNN		2		2			2							www.carepointadvantage.org	www.carepointadvantage.org	www.carepointadvantage.org	(888)657-1207		(201)432-2133	100	(855)593-5757		(201)432-2133	100	(855)479-3657		(201)432-2133	100	(855)593-5757		(201)432-2133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	007	0	1	04	01	H5141_007_0	15		1	08/03/2015	2016.01	08/03/2015 03:20:36 PM Eastern Daylight Time	08/03/2015 06:39:31 PM Eastern Daylight Time	08/03/2015 06:39:50 PM Eastern Daylight Time			08/03/2015 06:49:31 PM Eastern Daylight Time	CAREPOINT INSURANCE COMPANY	CarePoint Health Plans	www.carepointadvantage.org	Clover Health Premier (PPO)	01	04		1			H5141	007	0	2016	Counties: BER, ESX, HUD, MER, PAS, UNN		2		2			2							www.carepointadvantage.org	www.carepointadvantage.org	www.carepointadvantage.org	(888)657-1207		(201)432-2133	100	(855)593-5757		(201)432-2133	100	(855)479-3657		(201)432-2133	100	(855)593-5757		(201)432-2133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5167	001	0	1	20	08	H5167_001_0	1		1	05/28/2015	2016.01	05/28/2015 10:56:37 AM Mountain Daylight Time		05/19/2015 02:15:57 PM Mountain Daylight Time			05/28/2015 10:58:57 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	001	0	2016	Colorado Springs Metro Area		2		2			2								www.rmhcare.org	www.rmhcare.org									(855)207-0702	335	(719)314-2327	335	(855)207-0702	335	(719)314-2327	335									(855)207-0702	335	(719)314-2327	335	(855)207-0702	335	(719)314-2327	335															
H5167	002	0	1	20	08	H5167_002_0	1		1	05/28/2015	2016.01	05/28/2015 10:57:12 AM Mountain Daylight Time		05/19/2015 02:23:51 PM Mountain Daylight Time			05/28/2015 10:58:57 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	002	0	2016	Colorado Springs Metro Area		2		2			2								www.rmhcare.org	www.rmhcare.org									(855)207-0702	335	(719)314-2327	335	(855)207-0702	335	(719)314-2327	335									(855)207-0702	335	(719)314-2327	335	(855)207-0702	335	(719)314-2327	335															
H5172	002	0	1	48	05	H5172_002_0	3		1	08/13/2015	2016.01	08/13/2015 03:32:19 PM Pacific Daylight Time					08/13/2015 04:02:59 PM Pacific Daylight Time	COMMUNITY HEALTH GROUP	Community Health Group	www.chgsd.com	CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H5172	002	0	2016	San Diego, California		2		2			2							http://www.chgsd.com/physicianFinderLite.aspx	http://www.chgsd.com/	http://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				
H5190	001	0	1	01	01	H5190_001_0	6	2	1	08/12/2015	2016.01	08/12/2015 01:16:30 PM Central Daylight Time	08/03/2015 09:53:28 AM Pacific Daylight Time	07/30/2015 12:03:32 PM Pacific Daylight Time			08/12/2015 03:15:36 PM Pacific Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Sunshine Health	http://advantage.sunshinestatehealth.com	Sunshine Health Advantage (HMO SNP)	01	01		1			H5190	001	0	2016	13 Counties in Central and North Florida		2	498	2			1	3		1	4			http://advantage.sunshinehealth.com/home/find-a-provider-or-pharmacy/	http://advantage.sunshinehealth.com/home/prescription-drug-part-d-benefit-information/formulary/	http://advantage.sunshinehealth.com/home/find-a-provider-or-pharmacy/	(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	002	0	1	01	01	H5190_002_0	7	2	1	08/12/2015	2016.01	08/12/2015 01:17:47 PM Central Daylight Time	08/03/2015 09:53:51 AM Pacific Daylight Time	07/30/2015 12:05:25 PM Pacific Daylight Time			08/12/2015 03:15:36 PM Pacific Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Sunshine Health	http://advantage.sunshinestatehealth.com	Sunshine Health Advantage (HMO SNP)	01	01		1			H5190	002	0	2016	Counties: Hillsborough, Pasco, Pinellas, St. Lucie		2	282	2			1	3		1	4			http://advantage.sunshinehealth.com/home/find-a-provider-or-pharmacy/	http://advantage.sunshinehealth.com/home/prescription-drug-part-d-benefit-information/formulary/	http://advantage.sunshinehealth.com/home/find-a-provider-or-pharmacy/	(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	003	0	1	01	01	H5190_003_0	6	2	1	08/12/2015	2016.01	08/12/2015 01:19:15 PM Central Daylight Time	08/03/2015 09:54:16 AM Pacific Daylight Time	07/30/2015 12:06:54 PM Pacific Daylight Time			08/12/2015 03:15:36 PM Pacific Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Sunshine Health	http://advantage.sunshinestatehealth.com	Sunshine Health Advantage (HMO SNP)	01	01		1			H5190	003	0	2016	Counties: Broward, Palm Beach		2	162	2			1	3		1	4			http://advantage.sunshinehealth.com/home/find-a-provider-or-pharmacy/	http://advantage.sunshinehealth.com/home/prescription-drug-part-d-benefit-information/formulary/	http://advantage.sunshinehealth.com/home/find-a-provider-or-pharmacy/	(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	004	0	1	01	01	H5190_004_0	6	2	1	08/12/2015	2016.01	08/12/2015 01:24:04 PM Central Daylight Time	08/03/2015 10:24:20 AM Pacific Daylight Time	07/30/2015 12:07:55 PM Pacific Daylight Time			08/12/2015 03:15:36 PM Pacific Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Sunshine Health	http://advantage.sunshinestatehealth.com	Sunshine Health Advantage (HMO SNP)	01	01		1			H5190	004	0	2016	Miami-Dade County		2	103	2			1	3		1	4			http://advantage.sunshinehealth.com/home/find-a-provider-or-pharmacy/	http://advantage.sunshinehealth.com/home/prescription-drug-part-d-benefit-information/formulary/	http://advantage.sunshinehealth.com/home/find-a-provider-or-pharmacy/	(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5207	001	0	1	01	01	H5207_001_0	7	2	1	08/12/2015	2016.01	08/12/2015 02:42:15 PM Central Daylight Time	08/11/2015 11:31:06 AM Central Daylight Time	08/05/2015 03:39:44 PM Central Daylight Time			08/12/2015 02:43:46 PM Central Daylight Time	COMMUNITY CARE HEALTH PLAN, INC.	Community Care	www.communitycareinc.org	Community Care's Partnership Program (HMO SNP)	01	01		1			H5207	001	0	2016	Kenosha, Milwaukee, Racine and Waukesha Counties		2	283	2			1	3		1	5			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			
H5209	002	0	1	01	01	H5209_002_0	3	2	1	06/01/2015	2016.01	06/01/2015 10:53:34 AM Central Daylight Time	08/04/2015 08:18:10 AM Central Daylight Time	08/04/2015 08:18:09 AM Central Daylight Time			08/04/2015 08:23:45 AM Central Daylight Time	CARE WISCONSIN HEALTH PLAN, INC.	Care Wisconsin Health Plan, Inc.	www.carewisc.org/partnership	Partnership (HMO SNP)	01	01		1			H5209	002	0	2016	Southcentral and Eastern Wisconsin		2	1200	2			1	3		1	5			www.carewisc.org/partnership	www.carewisc.org/partnership	www.carewisc.org/partnership	(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;11a;11b;	2		1					1	2			
H5211	001	0	1	02	01	H5211_001_0	5		1	07/28/2015	2016.01	07/28/2015 02:18:00 PM Central Daylight Time	07/16/2015 01:06:40 PM Central Daylight Time				07/28/2015 03:46:23 PM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Advocare Spirit (HMO-POS)	01	02		1			H5211	001	0	2016	Central, Northern, Western and South Central WI		2	5568	2			2							www.securityhealth.org/medicareproviders	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicarepharmacies	(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	14		1	07/28/2015	2016.01	07/28/2015 02:43:22 PM Central Daylight Time	07/30/2015 07:18:10 AM Central Daylight Time	07/30/2015 07:14:24 AM Central Daylight Time			07/31/2015 09:43:08 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Advocare Essence Rx (HMO-POS)	01	02		1			H5211	002	0	2016	Central, Northern, Western and South Central WI		2	18054	2			2							www.securityhealth.org/medicareproviders	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicarepharmacies	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	003	0	1	02	01	H5211_003_0	5		1	07/28/2015	2016.01	07/28/2015 02:41:10 PM Central Daylight Time	07/16/2015 01:11:37 PM Central Daylight Time				07/28/2015 03:46:23 PM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Advocare Essence (HMO-POS)	01	02		1			H5211	003	0	2016	Central, Northern, Western and South Central WI		2	10333	2			2							www.securityhealth.org/medicareproviders	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicarepharmacies	(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	9		1	07/28/2015	2016.01	07/28/2015 02:26:44 PM Central Daylight Time	07/30/2015 07:19:53 AM Central Daylight Time	07/30/2015 07:19:08 AM Central Daylight Time			07/31/2015 09:43:08 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Advocare Spirit Rx (HMO-POS)	01	02		1			H5211	004	0	2016	Central, Northern, Western and South Central WI		2	11014	2			2							www.securityhealth.org/medicareproviders	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicarepharmacies	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	007	0	1	02	01	H5211_007_0	10		1	07/28/2015	2016.01	07/28/2015 02:56:03 PM Central Daylight Time	07/30/2015 10:48:12 AM Central Daylight Time	07/30/2015 07:20:33 AM Central Daylight Time			07/31/2015 09:43:08 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/medicareadvantage	Assurance RX (HMO-POS)	01	02		1			H5211	007	0	2016	Columbia,Dane,Green,Iowa,Marquette,Richland,Sauk		2	703	2			2							www.securityhealth.org/medicareproviders	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicarepharmacies	(844)622-0806		(715)221-9451		(715)221-9345		(715)221-9345		(844)622-0806		(715)221-9451		(888)456-2188		(715)221-9345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5212	001	0	1	20	08	H5212_001_0	2		1	05/18/2015	2016.01	05/18/2015 04:00:08 PM Central Daylight Time		05/18/2015 04:58:43 PM Central Daylight Time			05/19/2015 12:55:45 PM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.communitycareinc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	001	0	2016	Milwaukee County, Waukesha County		2		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	2		1	05/18/2015	2016.01	05/18/2015 03:59:17 PM Central Daylight Time		05/18/2015 04:59:55 PM Central Daylight Time			05/19/2015 12:55:45 PM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.CommunityCareInc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	002	0	2016	Milwaukee County, Waukesha County		2		2			2								www.CommunityCareInc.org	www.CommunityCareInc.org									(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000										(711)-		(711)-		(711)-		(711)-																
H5213	001	0	1	20	08	H5213_001_0	1		1	05/26/2015	2016.01	05/26/2015 01:51:25 PM Mountain Daylight Time		05/18/2015 02:54:51 PM Mountain Daylight Time			05/26/2015 01:56:20 PM Mountain Daylight Time	TOTAL COMMUNITY CARE, L.L.C.	Total Community Care	www.TotalCommunityCare.org	Total Community Care (PACE)	08	20		1			H5213	001	0	2016	Albuquerque Metro Area		2		2			2								www.TotalCommunityCare.org	www.pharmerica.com									(505)924-2608		(505)924-2608		(505)924-2608		(505)924-2608										(505)924-2608		(505)924-2608		(505)924-2608		(505)924-2608																
H5213	002	0	1	20	08	H5213_002_0	1		1	05/26/2015	2016.01	05/26/2015 01:51:48 PM Mountain Daylight Time		05/18/2015 03:02:34 PM Mountain Daylight Time			05/26/2015 01:56:20 PM Mountain Daylight Time	TOTAL COMMUNITY CARE, L.L.C.	Total Community Care	www.TotalCommunityCare.org	Total Community Care (PACE)	08	20		1			H5213	002	0	2016	Albuquerque Metro Area		2		2			2								www.TotalCommunityCare.org	www.pharmerica.com									(505)924-2608		(505)924-2608		(505)924-2608		(505)924-2608										(505)924-2608		(505)924-2608		(505)924-2608		(505)924-2608																
H5215	001	0	1	04	01	H5215_001_0	6		1	07/07/2015	2016.01	07/07/2015 11:11:31 AM Central Daylight Time	07/06/2015 02:37:26 PM Central Daylight Time				07/07/2015 12:26:38 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus (PPO)	01	04		1			H5215	001	0	2016	East Central Wisconsin		2	2793	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(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	07/07/2015	2016.01	07/07/2015 11:17:45 AM Central Daylight Time	08/04/2015 04:42:27 PM Central Daylight Time	08/05/2015 08:34:13 AM Central Daylight Time			08/05/2015 08:35:15 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus Pharmacy (PPO)	01	04		1			H5215	002	0	2016	East Central Wisconsin		2	13869	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(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	07/07/2015	2016.01	07/07/2015 11:17:51 AM Central Daylight Time	08/04/2015 04:42:29 PM Central Daylight Time	08/05/2015 08:34:14 AM Central Daylight Time			08/05/2015 08:35:15 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier Pharmacy (PPO)	01	04		1			H5215	005	0	2016	East Central Wisconsin		2	2485	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2						2			
H5215	006	0	1	04	01	H5215_006_0	7		1	07/07/2015	2016.01	07/07/2015 11:17:56 AM Central Daylight Time	07/20/2015 02:07:26 PM Central Daylight Time				07/20/2015 03:16:12 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier (PPO)	01	04		1			H5215	006	0	2016	East Central Wisconsin		2	902	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(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	9	2	1	08/04/2015	2016.01	08/04/2015 04:35:33 PM Central Daylight Time	08/04/2015 04:42:30 PM Central Daylight Time	08/05/2015 08:34:14 AM Central Daylight Time			08/05/2015 08:35:15 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	NetworkCares (PPO SNP)	01	04		1			H5215	007	0	2016	East Central Wisconsin		2	2797	2			1	3		1	2			www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(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	10		1	08/04/2015	2016.01	08/04/2015 04:38:18 PM Central Daylight Time	08/04/2015 04:42:32 PM Central Daylight Time	08/05/2015 08:34:15 AM Central Daylight Time			08/05/2015 08:35:15 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumSelect (PPO)	01	04		1			H5215	008	0	2016	East Central Wisconsin		2	44615	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2						2			
H5215	806	0	1	04	01	H5215_806_0	6		1	05/26/2015	2016.01	05/26/2015 03:16:36 PM Central Daylight Time	06/24/2015 08:27:40 PM Central Daylight Time				07/13/2015 01:35:41 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus Pharmacy EGP (PPO)	01	04		1			H5215	806	0	2016	East Central WI		1	300	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;11a;11b;11c;12;15;16b;	2		1						2			
H5215	807	0	1	04	01	H5215_807_0	5		1	05/26/2015	2016.01	05/26/2015 03:28:45 PM Central Daylight Time	06/25/2015 08:38:44 AM Central Daylight Time				07/13/2015 01:35:41 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier EGP (PPO)	01	04		1			H5215	807	0	2016	East Central WI		1	300	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;11a;11b;11c;12;15;16b;	2		1						2			
H5215	808	0	1	04	01	H5215_808_0	6		1	05/26/2015	2016.01	05/26/2015 03:30:42 PM Central Daylight Time	06/25/2015 08:50:52 AM Central Daylight Time				07/13/2015 01:35:41 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier Pharmacy EGP (PPO)	01	04		1			H5215	808	0	2016	East Central WI		1	300	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8b1;8b2;8b3;9a;9b;9c;11a;11b;11c;12;15;16b;	2		1						2			
H5216	001	0	1	04	01	H5216_001_0	3		1	07/08/2015	2016.01	07/08/2015 09:14:07 AM Eastern Daylight Time	08/04/2015 10:35:29 AM Eastern Daylight Time	07/29/2015 11:16:04 PM Eastern Daylight Time			08/04/2015 01:18:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-001 (PPO)	01	04		1			H5216	001	0	2016	Milwaukee area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	003	0	1	04	01	H5216_003_0	3		1	07/08/2015	2016.01	07/08/2015 09:09:28 AM Eastern Daylight Time	08/04/2015 10:48:26 AM Eastern Daylight Time	07/29/2015 11:16:40 PM Eastern Daylight Time			08/04/2015 01:18:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-003 (PPO)	01	04		1			H5216	003	0	2016	Green Bay Metro Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/09/2015	2016.01	07/09/2015 03:53:33 PM Eastern Daylight Time	08/04/2015 11:00:42 AM Eastern Daylight Time	07/29/2015 11:17:14 PM Eastern Daylight Time			08/04/2015 01:18:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-006 (PPO)	01	04		1			H5216	006	0	2016	Madison area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 09:14:43 AM Eastern Daylight Time	08/04/2015 10:51:46 AM Eastern Daylight Time	07/29/2015 11:17:50 PM Eastern Daylight Time			08/04/2015 01:18:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-009 (PPO)	01	04		1			H5216	009	0	2016	Southern Michigan area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	010	0	1	04	01	H5216_010_0	3		1	07/08/2015	2016.01	07/08/2015 09:19:56 AM Eastern Daylight Time	08/04/2015 11:06:30 AM Eastern Daylight Time	07/29/2015 11:18:26 PM Eastern Daylight Time			08/04/2015 01:18:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-010 (PPO)	01	04		1			H5216	010	0	2016	Central Michigan area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5253	004	0	1	01	01	H5253_004_0	3		1	07/31/2015	2016.01	07/31/2015 03:44:56 PM Central Daylight Time	08/03/2015 10:39:36 AM Central Daylight Time	07/30/2015 10:22:58 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	004	0	2016	Milwaukee Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	007	0	1	02	01	H5253_007_0	3		1	08/03/2015	2016.01	08/03/2015 08:53:46 AM Central Daylight Time	08/03/2015 10:40:11 AM Central Daylight Time	07/30/2015 10:23:16 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5253	007	0	2016	Select Counties in Wisconsin		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	011	0	1	01	01	H5253_011_0	3		1	07/31/2015	2016.01	07/31/2015 03:45:59 PM Central Daylight Time	08/03/2015 10:40:47 AM Central Daylight Time	07/30/2015 10:23:32 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	011	0	2016	Select counties in Wisconsin		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	021	0	1	01	01	H5253_021_0	2		1	05/28/2015	2016.01	05/28/2015 03:55:45 PM Central Daylight Time	05/29/2015 03:42:24 PM Central Daylight Time				07/13/2015 01:24:59 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H5253	021	0	2016	Milwaukee Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5253	024	0	1	01	01	H5253_024_0	3	2	1	05/28/2015	2016.01	05/28/2015 12:46:49 PM Central Daylight Time	08/03/2015 10:41:22 AM Central Daylight Time	07/30/2015 10:23:48 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO SNP)	01	01		1			H5253	024	0	2016	Select counties in Wisconsin		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	030	0	1	01	01	H5253_030_0	3		1	07/31/2015	2016.01	07/31/2015 03:46:55 PM Central Daylight Time	08/03/2015 10:41:57 AM Central Daylight Time	07/30/2015 10:24:03 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	030	0	2016	Jefferson, Kenosha and Rock 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	2			
H5253	033	0	1	01	01	H5253_033_0	3		1	08/03/2015	2016.01	08/03/2015 03:53:23 PM Central Daylight Time	08/03/2015 10:42:33 AM Central Daylight Time	07/30/2015 10:24:18 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Value (HMO)	01	01		1			H5253	033	0	2016	Milwaukee area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	034	0	1	01	01	H5253_034_0	3		1	07/31/2015	2016.01	07/31/2015 11:20:40 AM Central Daylight Time	08/03/2015 10:43:08 AM Central Daylight Time	07/30/2015 10:24:33 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Value (HMO)	01	01		1			H5253	034	0	2016	Green Bay area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	035	0	1	02	01	H5253_035_0	3		1	07/31/2015	2016.01	07/31/2015 12:04:41 PM Central Daylight Time	08/03/2015 10:43:44 AM Central Daylight Time	07/30/2015 10:24:48 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plus (HMO-POS)	01	02		1			H5253	035	0	2016	Southern Arizona Area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	036	0	1	01	01	H5253_036_0	3		1	07/31/2015	2016.01	07/31/2015 12:03:59 PM Central Daylight Time	08/03/2015 10:44:21 AM Central Daylight Time	07/30/2015 10:25:03 AM Central Daylight Time			08/03/2015 05:21:47 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H5253	036	0	2016	Yavapai county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	037	0	1	01	01	H5253_037_0	3		1	07/31/2015	2016.01	07/31/2015 02:18:23 PM Central Daylight Time	08/03/2015 10:44:57 AM Central Daylight Time	07/30/2015 10:25:18 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	037	0	2016	Select counties in North 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	1	01	7a;7d;7g;	
H5253	038	0	1	01	01	H5253_038_0	3		1	07/31/2015	2016.01	07/31/2015 02:19:06 PM Central Daylight Time	08/03/2015 10:46:25 AM Central Daylight Time	07/30/2015 10:25:34 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	038	0	2016	Select counties in North 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	1	01	7a;7d;7g;	
H5253	039	0	1	01	01	H5253_039_0	3		1	07/31/2015	2016.01	07/31/2015 02:19:51 PM Central Daylight Time	08/03/2015 10:47:00 AM Central Daylight Time	07/30/2015 10:25:50 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H5253	039	0	2016	Durham and Wake 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	2			
H5253	040	0	1	01	01	H5253_040_0	2		1	05/20/2015	2016.01	05/20/2015 10:49:12 AM Central Daylight Time	05/29/2015 03:46:29 PM Central Daylight Time				07/13/2015 11:29:32 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Essential (HMO)	01	01		1			H5253	040	0	2016	Select counties in North 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	1	01	7a;7d;7g;	
H5253	041	0	1	01	01	H5253_041_0	3	2	1	05/26/2015	2016.01	05/26/2015 08:36:19 AM Central Daylight Time	08/03/2015 10:47:34 AM Central Daylight Time	07/30/2015 10:26:09 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5253	041	0	2016	North Carolina		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	042	0	1	01	01	H5253_042_0	3		1	07/31/2015	2016.01	07/31/2015 09:46:26 AM Central Daylight Time	08/03/2015 10:48:09 AM Central Daylight Time	07/30/2015 10:26:26 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H5253	042	0	2016	Select Counties in North Carolina		2		2			1	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	08/03/2015	2016.01	08/03/2015 09:46:50 AM Central Daylight Time	08/03/2015 10:48:44 AM Central Daylight Time	07/30/2015 10:26:42 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS SNP)	01	02		1			H5253	043	0	2016	Select Counties in North Carolina		2		2			1	1	2	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	044	0	1	01	01	H5253_044_0	3		1	07/31/2015	2016.01	07/31/2015 11:21:41 AM Central Daylight Time	08/03/2015 10:49:19 AM Central Daylight Time	07/30/2015 10:26:59 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	044	0	2016	Select Counties in Iowa		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	045	0	1	01	01	H5253_045_0	3		1	07/31/2015	2016.01	07/31/2015 11:22:50 AM Central Daylight Time	08/03/2015 10:49:55 AM Central Daylight Time	07/30/2015 10:27:16 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	045	0	2016	Select Counties in Iowa		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	046	0	1	01	01	H5253_046_0	3		1	07/31/2015	2016.01	07/31/2015 11:23:45 AM Central Daylight Time	08/03/2015 10:50:31 AM Central Daylight Time	07/30/2015 10:27:32 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H5253	046	0	2016	Select counties in Illinois		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	047	0	1	01	01	H5253_047_0	3		1	07/31/2015	2016.01	07/31/2015 02:20:36 PM Central Daylight Time	08/03/2015 10:51:05 AM Central Daylight Time	07/30/2015 10:27:48 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	047	0	2016	Select counties in TN/VA		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	048	0	1	01	01	H5253_048_0	3		1	07/31/2015	2016.01	07/31/2015 02:24:32 PM Central Daylight Time	08/03/2015 10:51:40 AM Central Daylight Time	07/30/2015 10:28:03 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	048	0	2016	Select counties in TN/VA		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	049	0	1	01	01	H5253_049_0	3		1	07/31/2015	2016.01	07/31/2015 11:37:34 AM Central Daylight Time	08/03/2015 10:54:34 AM Central Daylight Time	07/30/2015 10:28:19 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 7 (HMO)	01	01		1			H5253	049	0	2016	Cleveland area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	050	0	1	01	01	H5253_050_0	3		1	07/31/2015	2016.01	07/31/2015 11:40:58 AM Central Daylight Time	08/03/2015 10:55:08 AM Central Daylight Time	07/30/2015 10:28:34 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5253	050	0	2016	Cleveland area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	051	0	1	01	01	H5253_051_0	4		1	08/04/2015	2016.01	08/04/2015 09:25:34 AM Central Daylight Time	08/03/2015 05:15:18 PM Central Daylight Time	07/30/2015 10:28:49 AM Central Daylight Time			08/04/2015 11:00:12 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5253	051	0	2016	Cleveland area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	052	0	1	01	01	H5253_052_0	3		1	08/04/2015	2016.01	08/04/2015 09:31:25 AM Central Daylight Time	08/04/2015 08:44:05 AM Central Daylight Time	07/30/2015 10:29:04 AM Central Daylight Time			08/04/2015 11:00:12 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 6 (HMO)	01	01		1			H5253	052	0	2016	Cincinnati/Dayton area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	053	0	1	01	01	H5253_053_0	3		1	08/04/2015	2016.01	08/04/2015 09:28:31 AM Central Daylight Time	08/03/2015 10:56:54 AM Central Daylight Time	07/30/2015 10:29:19 AM Central Daylight Time			08/04/2015 11:00:12 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H5253	053	0	2016	Select counties in Ohio and Kentucky		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	054	0	1	01	01	H5253_054_0	3		1	08/04/2015	2016.01	08/04/2015 09:29:17 AM Central Daylight Time	08/03/2015 05:15:54 PM Central Daylight Time	07/30/2015 10:29:34 AM Central Daylight Time			08/04/2015 11:00:12 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5253	054	0	2016	Cincinnati/Dayton area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	055	0	1	01	01	H5253_055_0	3		1	08/04/2015	2016.01	08/04/2015 09:30:11 AM Central Daylight Time	08/03/2015 05:16:36 PM Central Daylight Time	07/30/2015 10:29:50 AM Central Daylight Time			08/04/2015 11:00:12 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5253	055	0	2016	Toledo area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	056	0	1	01	01	H5253_056_0	3		1	07/31/2015	2016.01	07/31/2015 11:45:16 AM Central Daylight Time	08/03/2015 10:58:42 AM Central Daylight Time	07/30/2015 10:30:05 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 4 (HMO)	01	01		1			H5253	056	0	2016	Toledo area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	057	0	1	01	01	H5253_057_0	3		1	07/31/2015	2016.01	07/31/2015 11:46:51 AM Central Daylight Time	08/03/2015 10:59:16 AM Central Daylight Time	07/30/2015 10:30:21 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 8 (HMO)	01	01		1			H5253	057	0	2016	Toledo area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	058	0	1	01	01	H5253_058_0	2		1	05/28/2015	2016.01	05/28/2015 03:59:03 PM Central Daylight Time	05/29/2015 03:53:17 PM Central Daylight Time				07/13/2015 01:24:59 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Essential (HMO)	01	01		1			H5253	058	0	2016	Select Ohio 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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5253	059	0	1	01	01	H5253_059_0	3	2	1	05/26/2015	2016.01	05/26/2015 08:36:25 AM Central Daylight Time	08/03/2015 10:59:52 AM Central Daylight Time	07/30/2015 10:30:38 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5253	059	0	2016	Various counties in Ohio		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(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	2		1	07/31/2015	2016.01	07/31/2015 09:46:39 AM Central Daylight Time	08/03/2015 11:00:57 AM Central Daylight Time	07/30/2015 10:30:57 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5253	060	0	2016	Select Counties in Ohio		2		2			1	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	05/29/2015	2016.01	05/29/2015 06:12:09 PM Central Daylight Time	08/03/2015 11:01:30 AM Central Daylight Time	07/30/2015 10:31:14 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS SNP)	01	02		1			H5253	061	0	2016	Select Counties in Ohio		2		2			1	1	2	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	062	0	1	01	01	H5253_062_0	3		1	07/31/2015	2016.01	07/31/2015 11:47:50 AM Central Daylight Time	08/03/2015 11:02:05 AM Central Daylight Time	07/30/2015 10:31:31 AM Central Daylight Time			08/03/2015 04:47:41 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 5 (HMO)	01	01		1			H5253	062	0	2016	Central Ohio area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	063	0	1	01	01	H5253_063_0	3		1	08/04/2015	2016.01	08/04/2015 09:30:59 AM Central Daylight Time	08/03/2015 05:17:23 PM Central Daylight Time	07/30/2015 10:31:47 AM Central Daylight Time			08/04/2015 11:00:12 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5253	063	0	2016	Central Ohio area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	064	0	1	02	01	H5253_064_0	3		1	05/29/2015	2016.01	05/29/2015 06:12:25 PM Central Daylight Time	08/03/2015 11:03:16 AM Central Daylight Time	07/30/2015 10:32:03 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS SNP)	01	02		1			H5253	064	0	2016	Select Counties in Wisconsin		2		2			1	1	2	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	065	0	1	01	01	H5253_065_0	3	2	1	05/29/2015	2016.01	05/29/2015 06:01:23 PM Central Daylight Time	08/03/2015 11:03:51 AM Central Daylight Time	07/30/2015 10:32:22 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5253	065	0	2016	Milwaukee county		2		2			1	3		1	3		2	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(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	04/13/2015	2016.01	04/13/2015 02:18:15 PM Central Daylight Time	05/29/2015 03:55:41 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	801	0	2016	Milwaukee and Green Bay Area Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	802	0	1	01	01	H5253_802_0	1		1	04/13/2015	2016.01	04/13/2015 02:18:41 PM Central Daylight Time	05/29/2015 03:56:05 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	802	0	2016	Milwaukee and Green Bay Area Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H5253	805	0	1	01	01	H5253_805_0	1		1	04/13/2015	2016.01	04/13/2015 02:19:33 PM Central Daylight Time	05/29/2015 03:56:29 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	805	0	2016	Select Counties in WI		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	810	0	1	01	01	H5253_810_0	1		1	04/23/2015	2016.01	04/23/2015 03:08:26 PM Central Daylight Time	05/30/2015 02:23:53 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	810	0	2016	Arizona		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	811	0	1	01	01	H5253_811_0	1		1	04/23/2015	2016.01	04/23/2015 03:08:50 PM Central Daylight Time	05/30/2015 02:24:23 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	811	0	2016	Arizona		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	812	0	1	01	01	H5253_812_0	1		1	04/23/2015	2016.01	04/23/2015 03:09:23 PM Central Daylight Time	05/30/2015 02:24:55 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	812	0	2016	Arizona		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H5253	813	0	1	01	01	H5253_813_0	1		1	04/23/2015	2016.01	04/23/2015 03:10:41 PM Central Daylight Time	05/30/2015 02:25:26 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	813	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	814	0	1	01	01	H5253_814_0	1		1	04/23/2015	2016.01	04/23/2015 03:11:08 PM Central Daylight Time	05/30/2015 02:25:56 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	814	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	815	0	1	01	01	H5253_815_0	1		1	05/30/2015	2016.01	05/30/2015 05:16:52 PM Central Daylight Time	05/30/2015 02:26:27 PM Central Daylight Time				05/30/2015 05:17:18 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	815	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H5253	816	0	2	01	01	H5253_816_0	1		1	04/23/2015	2016.01	04/23/2015 03:05:47 PM Central Daylight Time	05/30/2015 02:26:59 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H5253	816	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	817	0	2	01	01	H5253_817_0	1		1	04/23/2015	2016.01	04/23/2015 03:06:13 PM Central Daylight Time	05/30/2015 02:27:30 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H5253	817	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	818	0	1	01	01	H5253_818_0	1		1	04/23/2015	2016.01	04/23/2015 03:13:58 PM Central Daylight Time	05/29/2015 04:00:09 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	818	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	819	0	1	01	01	H5253_819_0	1		1	04/23/2015	2016.01	04/23/2015 03:13:35 PM Central Daylight Time	05/29/2015 04:00:34 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	819	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H5253	820	0	1	01	01	H5253_820_0	1		1	04/23/2015	2016.01	04/23/2015 03:13:11 PM Central Daylight Time	05/29/2015 04:00:58 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	820	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	821	0	1	01	01	H5253_821_0	1		1	04/23/2015	2016.01	04/23/2015 03:15:09 PM Central Daylight Time	05/29/2015 04:01:23 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	821	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5253	822	0	1	01	01	H5253_822_0	1		1	04/23/2015	2016.01	04/23/2015 03:15:59 PM Central Daylight Time	05/29/2015 04:01:47 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	822	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1	2			
H5253	823	0	1	01	01	H5253_823_0	1		1	04/23/2015	2016.01	04/23/2015 03:15:36 PM Central Daylight Time	05/29/2015 04:02:11 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	823	0	2016	TBD		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1	2			
H5256	001	0	1	18	06	H5256_001_0	2		2	07/31/2015	2016.01	07/31/2015 10:02:12 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthcare.com	Medical Associates SmartPlan (Cost)	06	18		1			H5256	001	0	2016	Grant, Crawford, Iowa, Lafayette Counties		2	2625	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H5256	002	0	1	18	06	H5256_002_0	2		2	07/31/2015	2016.01	07/31/2015 10:03:31 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthcare.com	Medical Associates Community Plan (Cost)	06	18		1			H5256	002	0	2016	Grant, Crawford, Iowa, Lafayette Counties		2	350	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H5256	004	0	1	18	06	H5256_004_0	2		2	07/31/2015	2016.01	07/31/2015 10:05:00 AM Central Daylight Time					07/31/2015 10:16:11 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthcare.com	Medical Associates Freedom Plan (Cost)	06	18		1			H5256	004	0	2016	Grant, Crawford, Iowa, Lafayette Counties		2	245	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2	2			
H5262	001	0	1	01	01	H5262_001_0	4		1	07/02/2015	2016.01	07/02/2015 10:12:19 PM Central Daylight Time	05/29/2015 01:55:45 PM Central Daylight Time	06/01/2015 12:52:37 PM Central Daylight Time			07/02/2015 10:50:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Gundersen Health Plan, Inc.	www.seniorpreferred.org	Gundersen Senior Preferred Elite (w/Rx) (HMO)	01	01		1			H5262	001	0	2016	La Crosse and SW Wisconsin and NE Iowa		2	6776	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	http://www.gundersenhealthplan.org/PartDFormulary	http://www.gundersenhealthplan.org/providerdirectory	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	003	0	1	01	01	H5262_003_0	4		1	07/02/2015	2016.01	07/02/2015 10:12:03 PM Central Daylight Time	05/29/2015 01:56:03 PM Central Daylight Time	06/01/2015 12:53:09 PM Central Daylight Time			07/02/2015 10:50:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Gundersen Health Plan, Inc.	www.seniorpreferred.org	Gundersen Senior Preferred Value (w/Rx) (HMO)	01	01		1			H5262	003	0	2016	La Crosse and SW Wisconsin and NE Iowa		2	4242	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	http://www.gundersenhealthplan.org/PartDFormulary	http://www.gundersenhealthplan.org/providerdirectory	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(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	2		1	07/02/2015	2016.01	07/02/2015 10:12:52 PM Central Daylight Time	05/29/2015 01:57:56 PM Central Daylight Time				07/02/2015 10:50:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Gundersen Health Plan, Inc.	www.seniorpreferred.org	Gundersen Senior Preferred Value (no Rx) (HMO)	01	01		1			H5262	004	0	2016	La Crosse and SW Wisconsin and NE Iowa		2	1411	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	N/A	N/A	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	005	0	1	01	01	H5262_005_0	2		1	07/02/2015	2016.01	07/02/2015 10:15:01 PM Central Daylight Time	05/29/2015 01:57:31 PM Central Daylight Time				07/02/2015 10:50:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN	Gundersen Health Plan, Inc.	www.seniorpreferred.org	Gundersen Senior Preferred Elite (no Rx) (HMO)	01	01		1			H5262	005	0	2016	La Crosse and SW Wisconsin and NE Iowa		2	2325	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	N/A	N/A	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5264	002	0	1	18	06	H5264_002_0	3		2	07/07/2015	2016.01	07/07/2015 10:38:40 AM Central Daylight Time					07/07/2015 10:43:40 AM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Enhanced (Cost)	06	18		1			H5264	002	0	2016	South Central Wisconsin		2	19200	2			2							www.deancare.com/doctors-locations			(888)422-3326		(608)827-4372		(888)422-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5264	003	0	1	18	06	H5264_003_0	2		2	06/01/2015	2016.01	06/01/2015 01:52:34 PM Central Daylight Time					06/01/2015 02:07:03 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Basic (Cost)	06	18		1			H5264	003	0	2016	South Central Wisconsin		2	125	2			2							www.deancare.com/doctors-locations	www.deancare.com/drugformulary	www.deancare.com/pharmacy	(888)422-3326		(608)827-4372		(888)422-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5264	005	0	1	18	06	H5264_005_0	3		2	07/07/2015	2016.01	07/07/2015 10:37:57 AM Central Daylight Time					07/07/2015 10:43:40 AM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Shared Value (Cost)	06	18		1			H5264	005	0	2016	South Central Wisconsin		2	4000	2			2							www.deancare.com/doctors-locations	www.deancare.com/drugformulary	www.deancare.com/pharmacy	(888)422-3326		(608)827-4372		(888)422-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5280	001	0	1	48	05	H5280_001_0	5		1	08/13/2015	2016.01	08/13/2015 12:22:37 PM Pacific Daylight Time					08/13/2015 01:01:42 PM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/duals	Molina Dual Options  MyCareOhio (Medicare-Medicaid Plan)	05	48		1			H5280	001	0	2016	Southwest, West Central, and Central 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)-		2					2					2				
H5294	001	0	1	01	01	H5294_001_0	7	2	1	08/12/2015	2016.01	08/12/2015 01:41:01 PM Central Daylight Time	08/03/2015 09:55:09 AM Pacific Daylight Time	07/30/2015 12:09:19 PM Pacific Daylight Time			08/12/2015 03:15:36 PM Pacific Daylight Time	SUPERIOR HEALTH PLAN, INC.	Superior HealthPlan	http:advantage.superiorhealthplan.com	Superior HealthPlan Advantage (HMO SNP)	01	01		1			H5294	001	0	2016	Bexar, Collin, Dallas, Nueces, Rockwall Counties		2	592	2			1	3		1	3		2	http://advantage.superiorhealthplan.com/home/find-a-provider-or-pharmacy/	http://advantage.superiorhealthplan.com/home/prescription-drug-part-d-benefit-information/formulary/	http://advantage.superiorhealthplan.com/home/find-a-provider-or-pharmacy/	(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)-		2					2					2	2			
H5302	011	0	1	02	01	H5302_011_0	8		1	07/31/2015	2016.01	07/31/2015 11:08:16 AM Eastern Daylight Time	07/31/2015 12:54:06 PM Eastern Daylight Time	07/29/2015 05:32:12 PM Eastern Daylight Time			08/01/2015 05:48:36 PM Eastern Daylight Time	AETNA HEALTH, INC. (GEORGIA)	Coventry Health Care	Http://ga.chcadvantra.com	Advantra Platinum (HMO-POS)	01	02		1			H5302	011	0	2016	Atlanta Savannah Area		2	150	2			2							Http://Providerdirectory.Coventry-Medicare.com	Http://GAformulary.Coventry-Medicare.com	Http://Pharmacylocator.Coventry-Medicare.com	(866)613-4977		(866)613-4977		(855)338-9551		(855)338-9551		(800)690-3412		(800)690-3412		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	809	0	1	01	01	H5302_809_0	2		1	07/17/2015	2016.01	07/17/2015 11:11:02 AM Eastern Daylight Time	07/17/2015 12:03:16 PM Eastern Daylight Time				07/17/2015 12:13:14 PM Eastern Daylight Time	AETNA HEALTH, INC. (GEORGIA)	Coventry Health Care	http://ga.chcadvantra.com	Advantra (HMO)	01	01		1			H5302	809	0	2016	Georgia		1	100	2			2							http://Providerdirectory.Coventry-Medicare.com	http://GAformulary.Coventry-Medicare.com	http://Pharmacylocator.Coventry-Medicare.com	(866)613-4977		(866)613-4977		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1					1	2			
H5302	810	0	1	01	01	H5302_810_0	2		1	07/17/2015	2016.01	07/17/2015 11:11:59 AM Eastern Daylight Time	07/17/2015 12:04:18 PM Eastern Daylight Time				07/17/2015 12:13:14 PM Eastern Daylight Time	AETNA HEALTH, INC. (GEORGIA)	Coventry Health Care	http://ga.chcadvantra.com	Advantra (HMO)	01	01		1			H5302	810	0	2016	Georgia		1	100	2			2							http://Providerdirectory.Coventry-Medicare.com	http://GAformulary.Coventry-Medicare.com	http://Pharmacylocator.coventry-Medicare.com	(866)613-4977		(866)613-4977		(855)338-9551		(855)338-9551		(800)690-3412		(800)690-3412		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1					1	2			
H5322	001	0	1	02	01	H5322_001_0	3		1	08/03/2015	2016.01	08/03/2015 09:46:25 AM Central Daylight Time	07/31/2015 02:08:14 PM Central Daylight Time	07/30/2015 10:32:39 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5322	001	0	2016	Select Counties in AL, MO, NM, OH, SC and VA		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	003	0	1	01	01	H5322_003_0	3		1	07/31/2015	2016.01	07/31/2015 03:54:52 PM Central Daylight Time	07/31/2015 02:08:39 PM Central Daylight Time	07/30/2015 10:32:56 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H5322	003	0	2016	Select Counties in FL, IN and NJ		2		2			1	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	3		1	05/26/2015	2016.01	05/26/2015 12:15:09 PM Central Daylight Time	07/31/2015 02:09:04 PM Central Daylight Time	07/30/2015 10:33:13 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5322	004	0	2016	Atlanta and Augusta Metro areas		2		2			1	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	011	0	1	02	01	H5322_011_0	3		1	05/26/2015	2016.01	05/26/2015 12:14:34 PM Central Daylight Time	07/31/2015 02:09:29 PM Central Daylight Time	07/30/2015 10:36:14 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5322	011	0	2016	Allegheny, Lebanon and Westmoreland counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	024	0	1	01	01	H5322_024_0	3		1	07/31/2015	2016.01	07/31/2015 02:25:26 PM Central Daylight Time	07/31/2015 02:09:54 PM Central Daylight Time	07/30/2015 10:36:30 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5322	024	0	2016	Grafton, Hillsborough, and Rockingham 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	2			
H5355	001	0	1	48	05	H5355_001_0	4		1	09/04/2015	2016.01	09/04/2015 04:50:47 PM Pacific Daylight Time					09/04/2015 04:52:49 PM Pacific Daylight Time	IEHP HEALTH ACCESS	IEHP DualChoice	www.iehp.org	IEHP DualChoice (Medicare-Medicaid Plan)	05	48		1			H5355	001	0	2016	Riverside and San Bernardino Counties		2	22500	2			2							www.iehp.org	www.iehp.org	www.iehp.org	(877)273-4347		(877)273-4347		(800)741-4347		(800)741-4347		(877)273-4347		(877)273-4347		(800)741-4347		(800)741-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		2					2					2				
H5386	001	0	1	01	01	H5386_001_0	2		1	05/29/2015	2016.01	05/29/2015 09:30:22 AM Pacific Daylight Time	07/31/2015 10:47:24 AM Pacific Daylight Time	07/31/2015 10:47:22 AM Pacific Daylight Time			07/31/2015 04:50:42 PM Pacific Daylight Time	SHARP HEALTH PLAN	North County Select	www.northcountyselect.com	North County Select (HMO)	01	01		1			H5386	001	0	2016	92010, 92056, 92069, 92078, 92081, 92083		2	100	2			2							www.northcountyselect.com	www.northcountyselect.com	www.northcountyselect.com	(866)336-0072		(866)336-0072		(866)336-0072		(866)336-0072		(866)336-0072		(866)336-0072		(866)336-0072		(866)336-0072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5386	801	0	1	01	01	H5386_801_0	1		1	05/23/2015	2016.01	05/23/2015 10:38:22 AM Pacific Daylight Time	05/26/2015 05:24:48 PM Pacific Daylight Time				05/29/2015 06:16:49 PM Pacific Daylight Time	SHARP HEALTH PLAN	North County Select	www.sharphealthplan.com/sharpadvantage	Sharp Advantage Calendar Year (HMO)	01	01		1			H5386	801	0	2016	Sharp Advantage San Diego County		1	1000	2			2							www.sharphealthplan.com/sharpadvantage	www.sharphealthplan.com/sharpadvantage	www.sharphealthplan.com/sharpadvantage	(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5386	802	0	1	01	01	H5386_802_0	1		1	05/23/2015	2016.01	05/23/2015 10:38:33 AM Pacific Daylight Time	05/26/2015 05:24:12 PM Pacific Daylight Time				05/29/2015 06:16:49 PM Pacific Daylight Time	SHARP HEALTH PLAN	North County Select	www.sharphealthplan.com/sharpadvantage	Sharp Advantage Non-Calendar Year (HMO)	01	01		1			H5386	802	0	2016	Sharp Advantage San Diego County		1	1000	2			2							www.sharphealthplan.com/sharpadvantage	www.sharphealthplan.com/sharpadvantage	www.sharphealthplan.com/sharpadvantage	(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5386	803	0	1	01	01	H5386_803_0	1		1	05/23/2015	2016.01	05/23/2015 10:03:10 AM Pacific Daylight Time	05/27/2015 09:40:23 AM Pacific Daylight Time				05/29/2015 06:16:49 PM Pacific Daylight Time	SHARP HEALTH PLAN	North County Select	www.sharphealthplan.com/sharpadvantage	Sharp Advantage MA Only (HMO)	01	01		1			H5386	803	0	2016	Sharp Advantage San Diego County		1	1000	2			2							www.sharphealthplan.com/sharpadvantage	www.sharphealthplan.com/sharpadvantage	www.sharphealthplan.com/sharpadvantage	(855)820-2112		(855)820-2112		(855)820-2112		(855)820-2112										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5403	001	0	1	20	08	H5403_001_0	1		1	05/28/2015	2016.01	05/28/2015 06:36:31 PM Pacific Daylight Time		05/20/2015 01:36:19 PM Pacific Daylight Time			05/28/2015 06:41:26 PM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok Lifeways	www.onlok.org	On Lok Lifeways (Dual Eligibles) (PACE)	08	20		1			H5403	001	0	2016	San Francisco, Alameda and Santa Clara counties		2		2			2								N/A	www.onlok.org									(888)996-6565		(415)292-8895		(888)886-6565		(415)292-8784										(888)996-6565		(415)292-8898		(888)886-6565		(415)292-8898																
H5403	002	0	1	20	08	H5403_002_0	1		1	05/28/2015	2016.01	05/28/2015 06:38:00 PM Pacific Daylight Time		05/20/2015 01:36:19 PM Pacific Daylight Time			05/28/2015 06:41:26 PM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok Lifeways	www.onlok.org	On Lok Lifeways (Medicare Only) (PACE)	08	20		1			H5403	002	0	2016	San Francisco, Alameda and Santa Clara counties		2		2			2								N/A	www.onlok.org									(888)996-6565		(415)292-8895		(888)886-6565		(415)292-8784										(888)996-6565		(415)292-8898		(888)886-6565		(415)292-8898																
H5405	001	0	1	20	08	H5405_001_0	3		1	05/20/2015	2016.01	05/20/2015 10:18:56 AM Pacific Daylight Time		05/20/2015 03:27:15 PM Pacific Daylight Time			05/21/2015 09:27:52 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	2016	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	3		1	05/20/2015	2016.01	05/20/2015 10:10:04 AM Pacific Daylight Time		05/20/2015 03:30:40 PM Pacific Daylight Time			05/21/2015 09:27:52 AM Pacific Daylight Time	CENTER FOR ELDERS INDEPENDENCE	Center For Elders' Independence	www.cei.elders.org	Center for Elders-Part D/MediCare, only (PACE)	08	20		1			H5405	002	0	2016	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	3		1	05/27/2015	2016.01	05/27/2015 12:40:27 PM Pacific Daylight Time		05/27/2015 07:23:44 AM Pacific Daylight Time			05/27/2015 12:42:20 PM Pacific Daylight Time	SUTTER HEALTH SACRAMENTO SIERRA REGION	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	08	20		1			H5406	001	0	2016	Sacramento Counties		2		2			2							N/A	N/A	N/A									(916)424-8412	13415	(916)424-8412	13404	(916)424-8412		(916)424-8412	13422									(916)424-8412		(916)424-8412		(916)424-8412		(916)424-8412																
H5406	002	0	1	20	08	H5406_002_0	3		1	05/27/2015	2016.01	05/27/2015 12:40:58 PM Pacific Daylight Time		05/27/2015 07:24:37 AM Pacific Daylight Time			05/27/2015 12:42:20 PM Pacific Daylight Time	SUTTER HEALTH SACRAMENTO SIERRA REGION	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	08	20		1			H5406	002	0	2016	Sacramento Counties		2		2			2							N/A	N/A	N/A									(916)424-8412	13415	(916)424-8412	13404	(916)424-8412		(916)424-8412	13422									(916)424-8412		(916)424-8412		(916)424-8412		(916)424-8412																
H5410	001	0	1	01	01	H5410_001_0	5		1	07/14/2015	2016.01	07/14/2015 11:27:53 AM Central Daylight Time	07/31/2015 10:27:34 AM Central Daylight Time	07/30/2015 08:31:17 AM Central Daylight Time			08/03/2015 09:29:49 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.lmchealthplans.com	Leon Medical Centers Health Plans - Leon Cares (HMO)	01	01		1			H5410	001	0	2016	Miami-Dade county		2	0	2			2								www.lmchealthplans.com	www.cignahealthspring.com	(866)393-5366		(305)559-5366		(866)393-5366		(305)559-5366		(866)393-5366		(305)559-5366		(866)393-5366		(305)559-5366		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	004	0	1	01	01	H5410_004_0	4		1	07/09/2015	2016.01	07/09/2015 04:43:12 PM Central Daylight Time	07/12/2015 09:56:38 AM Central Daylight Time				07/16/2015 09:50:25 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H5410	004	0	2016	Northern Florida		2		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5410	013	0	1	01	01	H5410_013_0	5	2	1	07/14/2015	2016.01	07/14/2015 04:03:18 PM Central Daylight Time	08/01/2015 09:48:15 AM Central Daylight Time	07/30/2015 08:31:49 AM Central Daylight Time			08/03/2015 03:57:29 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H5410	013	0	2016	Northern Florida		2		2			1	3		1	2				www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	018	0	1	02	01	H5410_018_0	6		1	07/14/2015	2016.01	07/14/2015 04:03:02 PM Central Daylight Time	08/01/2015 09:48:45 AM Central Daylight Time	07/30/2015 08:32:17 AM Central Daylight Time			08/03/2015 03:57:29 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H5410	018	0	2016	Northern Florida		2		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(800)668-3813		(800)668-3813		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	807	0	1	01	01	H5410_807_0	4		1	05/21/2015	2016.01	05/21/2015 09:08:43 PM Central Daylight Time	07/10/2015 10:03:47 PM Central Daylight Time				07/16/2015 11:02:24 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H5410	807	0	2016	Statewide Florida		1		2			2								www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;12;14a;14d;15;	1	1a;1b;2;5;6;7c;7d;7e;7g;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;	1					1	2			
H5414	019	0	1	01	01	H5414_019_0	10		1	08/02/2015	2016.01	08/02/2015 10:16:46 AM Eastern Daylight Time	07/31/2015 04:21:05 PM Eastern Daylight Time	07/29/2015 05:32:31 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5414	019	0	2016	North FL		2		2			2							www.aetnamedicare.com	www.aetnamedicare.com	www.aetnamedicare.com	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	023	0	1	01	01	H5414_023_0	9		1	08/02/2015	2016.01	08/02/2015 10:17:39 AM Eastern Daylight Time	07/31/2015 03:29:26 PM Eastern Daylight Time	07/29/2015 05:32:50 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5414	023	0	2016	Southwest FL		2		2			2							www.aetnamedicare.com	www.aetnamedicare.com	www.aetnamedicare.com	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	024	0	1	01	01	H5414_024_0	7		1	07/31/2015	2016.01	07/31/2015 05:29:36 PM Eastern Daylight Time	07/31/2015 03:32:27 PM Eastern Daylight Time	07/29/2015 05:33:09 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5414	024	0	2016	Central FL		2		2			2							www.aetnamedicare.com	www.aetnamedicare.com	www.aetnamedicare.com	(855)423-9420		(855)423-9420		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	025	0	1	01	01	H5414_025_0	6		1	08/08/2015	2016.01	08/08/2015 09:40:24 AM Eastern Daylight Time	08/06/2015 04:13:34 PM Eastern Daylight Time	08/06/2015 03:54:28 PM Eastern Daylight Time			08/08/2015 09:56:18 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Connect Plus (HMO)	01	01		1			H5414	025	0	2016	Florida		2		2			2							www.aetnamedicare.com	www.aetnamedicare.com	www.aetnamedicare.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	026	0	1	01	01	H5414_026_0	8		1	07/31/2015	2016.01	07/31/2015 06:09:39 PM Eastern Daylight Time	07/31/2015 05:04:29 PM Eastern Daylight Time	07/29/2015 05:33:28 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H5414	026	0	2016	West, Central and North FL		2		2			2							www.aetnamedicare.com	www.aetnamedicare.com	www.aetnamedicare.com	(855)423-9420		(855)423-9420		(855)338-9551		(855)338-9551		(866)797-8648		(866)797-8648		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	027	0	1	01	01	H5414_027_0	7		1	07/31/2015	2016.01	07/31/2015 06:15:29 PM Eastern Daylight Time	07/31/2015 03:35:38 PM Eastern Daylight Time	07/29/2015 05:33:47 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Vista Ideal (HMO)	01	01		1			H5414	027	0	2016	South FL		2	3000	2			2							www.coventry-medicare.com	www.coventry-medicare.com	www.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(866)797-8648		(866)797-8648		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	028	0	1	01	01	H5414_028_0	7		1	07/31/2015	2016.01	07/31/2015 06:31:39 PM Eastern Daylight Time	07/31/2015 03:36:51 PM Eastern Daylight Time	07/29/2015 05:34:06 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Vista Ideal (HMO)	01	01		1			H5414	028	0	2016	South FL		2	1275	2			2							www.coventry-medicare.com	www.coventry-medicare.com	www.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(866)797-8648		(866)797-8648		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	029	0	1	01	01	H5414_029_0	7	2	1	07/10/2015	2016.01	07/10/2015 11:46:45 AM Eastern Daylight Time	07/31/2015 04:16:09 PM Eastern Daylight Time	07/29/2015 05:34:25 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Vista Maximum (HMO SNP)	01	01		1			H5414	029	0	2016	South FL		2	500	2			1	3		1	2			www.coventry-medicare.com	www.coventry-medicare.com	www.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(866)797-8648		(866)797-8648		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	030	0	1	01	01	H5414_030_0	7	2	1	07/09/2015	2016.01	07/09/2015 01:07:37 PM Eastern Daylight Time	07/31/2015 03:43:21 PM Eastern Daylight Time	07/29/2015 05:34:45 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Summit Maximum (HMO SNP)	01	01		1			H5414	030	0	2016	South FL		2	8750	2			1	3		1	2			www.coventry-medicare.com	www.coventry-medicare.com	www.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(866)797-8648		(866)797-8648		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	031	0	1	01	01	H5414_031_0	7		1	07/31/2015	2016.01	07/31/2015 06:32:23 PM Eastern Daylight Time	07/31/2015 03:45:51 PM Eastern Daylight Time	07/29/2015 05:35:04 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Summit Ideal (HMO)	01	01		1			H5414	031	0	2016	South FL		2	5500	2			2							www.coventry-medicare.com	www.coventry-medicare.com	www.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(866)797-8648		(866)797-8648		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	032	0	1	01	01	H5414_032_0	6		1	07/31/2015	2016.01	07/31/2015 05:34:28 PM Eastern Daylight Time	07/31/2015 03:56:27 PM Eastern Daylight Time	07/29/2015 05:35:23 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Summit Ideal (HMO)	01	01		1			H5414	032	0	2016	South FL		2	7000	2			2							www.coventry-medicare.com	www.coventry-medicare.com	www.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(866)797-8648		(866)797-8648		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	033	0	1	01	01	H5414_033_0	7		1	08/02/2015	2016.01	08/02/2015 10:18:52 AM Eastern Daylight Time	07/31/2015 04:02:53 PM Eastern Daylight Time	07/29/2015 05:35:42 PM Eastern Daylight Time			08/02/2015 10:52:54 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Summit Ideal (HMO)	01	01		1			H5414	033	0	2016	Central, North and South FL		2	6000	2			2							www.coventry-medicare.com	www.coventry-medicare.com	www.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(866)797-8648		(866)797-8648		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	034	0	1	01	01	H5414_034_0	7	2	1	07/31/2015	2016.01	07/31/2015 06:47:07 PM Eastern Daylight Time	08/04/2015 04:30:27 PM Eastern Daylight Time	07/29/2015 05:36:01 PM Eastern Daylight Time			08/07/2015 06:14:22 PM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.coventry-medicare.com	Coventry Summit Maximum (HMO SNP)	01	01		1			H5414	034	0	2016	South and Central FL		2	5750	2			1	3		1	2			www.coventry-medicare.com	www.coventry-medicare.com	www.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)338-9551		(855)338-9551		(866)797-8648		(866)797-8648		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5414	801	0	1	01	01	H5414_801_0	2		1	05/29/2015	2016.01	05/29/2015 03:43:29 PM Eastern Daylight Time	07/16/2015 05:23:48 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5414	801	0	2016	Florida		1	701	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1	2			
H5414	803	0	1	01	01	H5414_803_0	2		1	05/29/2015	2016.01	05/29/2015 03:44:20 PM Eastern Daylight Time	07/16/2015 05:23:41 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H5414	803	0	2016	Florida		1	842	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H5415	056	0	1	04	01	H5415_056_0	3		1	07/08/2015	2016.01	07/08/2015 07:47:26 AM Eastern Daylight Time	07/31/2015 05:56:43 PM Eastern Daylight Time	07/29/2015 11:19:02 PM Eastern Daylight Time			08/04/2015 03:05:48 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	HumanaChoice H5415-056 (PPO)	01	04		1			H5415	056	0	2016	Broward, Miami-Dade and Palm Beach counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5415	070	0	1	04	01	H5415_070_0	3		1	07/08/2015	2016.01	07/08/2015 07:36:13 AM Eastern Daylight Time	07/31/2015 06:21:58 PM Eastern Daylight Time	07/29/2015 11:19:38 PM Eastern Daylight Time			08/04/2015 02:11:12 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	HumanaChoice H5415-070 (PPO)	01	04		1			H5415	070	0	2016	Martin and St. Lucie counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5415	801	0	1	04	01	H5415_801_0	1		1	05/12/2015	2016.01	05/13/2015 11:36:34 AM Eastern Daylight Time	05/29/2015 10:58:41 AM Eastern Daylight Time				05/29/2015 11:27:21 AM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5415	801	0	2016	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5415	803	0	1	04	01	H5415_803_0	1		1	05/13/2015	2016.01	05/13/2015 12:33:42 PM Eastern Daylight Time	05/29/2015 11:09:34 AM Eastern Daylight Time				05/29/2015 11:27:21 AM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5415	803	0	2016	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5415	804	0	1	04	01	H5415_804_0	1		1	05/12/2015	2016.01	05/13/2015 11:37:48 AM Eastern Daylight Time	05/29/2015 11:02:46 AM Eastern Daylight Time				05/29/2015 11:27:21 AM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H5415	804	0	2016	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5415	806	0	2	04	01	H5415_806_0	1		1	05/13/2015	2016.01	05/13/2015 03:51:11 PM Eastern Daylight Time	05/29/2015 11:06:37 AM Eastern Daylight Time				05/29/2015 11:27:21 AM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5415	806	0	2016	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5415	807	0	2	04	01	H5415_807_0	1		1	05/14/2015	2016.01	05/14/2015 08:11:34 AM Eastern Daylight Time	05/29/2015 11:07:04 AM Eastern Daylight Time				05/29/2015 11:27:21 AM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5415	807	0	2016	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5415	808	0	2	04	01	H5415_808_0	1		1	05/14/2015	2016.01	05/14/2015 08:20:53 AM Eastern Daylight Time	05/29/2015 11:07:32 AM Eastern Daylight Time				05/29/2015 11:27:21 AM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H5415	808	0	2016	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5420	001	0	1	01	01	H5420_001_0	5		1	08/07/2015	2016.01	08/07/2015 10:51:29 AM Central Daylight Time	07/31/2015 01:17:08 PM Central Daylight Time	07/30/2015 10:38:11 AM Central Daylight Time			08/07/2015 11:07:40 AM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	Medica HealthCare Plans, Inc.	www.Medicaplans.com	Medica HealthCare Plans MedicareMax (HMO)	01	01		1			H5420	001	0	2016	Miami-Dade County		2		2			2							www.Medicaplans.com	www.Medicaplans.com	www.Medicaplans.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5420	003	0	1	01	01	H5420_003_0	4		1	08/07/2015	2016.01	08/07/2015 10:51:44 AM Central Daylight Time	07/31/2015 01:17:34 PM Central Daylight Time	07/30/2015 10:38:28 AM Central Daylight Time			08/07/2015 11:07:40 AM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	Medica HealthCare Plans, Inc.	www.Medicaplans.com	Medica HealthCare Plans MedicareMax (HMO)	01	01		1			H5420	003	0	2016	Broward County		2		2			2							www.Medicaplans.com	www.Medicaplans.com	www.Medicaplans.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5420	006	0	1	01	01	H5420_006_0	5	2	1	07/31/2015	2016.01	07/31/2015 02:28:01 PM Central Daylight Time	08/04/2015 09:36:25 AM Central Daylight Time	07/30/2015 10:38:46 AM Central Daylight Time			08/04/2015 10:44:41 AM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	Medica HealthCare Plans, Inc.	www.Medicaplans.com	Medica HealthCare Plans MedicareMax Plus (HMO SNP)	01	01		1			H5420	006	0	2016	Miami-Dade and Broward County		2		2			1	3		1	2			www.Medicaplans.com	www.Medicaplans.com	www.Medicaplans.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	007	0	1	01	01	H5422_007_0	9	2	1	07/31/2015	2016.01	07/31/2015 01:00:32 PM Eastern Daylight Time	08/04/2015 10:34:31 AM Eastern Daylight Time	07/30/2015 07:31:05 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BCBSHP MediBlue Dual Advantage (HMO SNP)	01	01		1			H5422	007	0	2016	Select Counties in Georgia		2	301	2			1	3		1	5			www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(855)690-7797		(855)690-7797		(844)316-0354		(844)316-0354		(855)690-7797		(855)690-7797		(844)316-0354		(844)316-0354		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	008	0	1	01	01	H5422_008_0	9		1	07/16/2015	2016.01	07/16/2015 03:39:34 PM Eastern Daylight Time	08/03/2015 04:16:32 PM Eastern Daylight Time	07/30/2015 06:41:45 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BCBSHP MediBlue Plus (HMO)	01	01		1			H5422	008	0	2016	Select Counties in Georgia		2	1730	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(855)690-7797		(855)690-7797		(800)797-1769		(800)797-1769		(855)690-7797		(855)690-7797		(844)364-2117		(844)364-2117		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	009	0	1	01	01	H5422_009_0	7		1	08/05/2015	2016.01	08/05/2015 04:57:21 PM Eastern Daylight Time	08/01/2015 09:36:13 PM Eastern Daylight Time	07/30/2015 06:34:37 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BCBSHP MediBlue Prime Select (HMO)	01	01		1			H5422	009	0	2016	Clayton, Dekalb, and Fulton Counties		2	757	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(855)690-7797		(855)690-7797		(800)797-1769		(800)797-1769		(855)690-7797		(855)690-7797		(844)364-2117		(844)364-2117		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7d;7e1;7e2;7f;7h1;7h2;	
H5422	803	0	1	01	01	H5422_803_0	3		1	05/20/2015	2016.01	05/20/2015 11:39:26 AM Pacific Daylight Time	05/31/2015 03:03:49 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BlueValue (HMO)	01	01		1			H5422	803	0	2016	Georgia Select Counties		1	50	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H5422	804	0	1	01	01	H5422_804_0	3		1	05/20/2015	2016.01	05/20/2015 11:39:33 AM Pacific Daylight Time	05/31/2015 03:03:53 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BlueValue (HMO)	01	01		1			H5422	804	0	2016	Georgia - Select Counties		1	50	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H5425	001	0	1	01	01	H5425_001_0	10		1	07/08/2015	2016.01	07/08/2015 09:28:28 AM Pacific Daylight Time	08/03/2015 12:05:44 PM Pacific Daylight Time	07/29/2015 01:42:10 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	001	0	2016	Ventura County		2	1000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	004	0	1	01	01	H5425_004_0	5		1	07/02/2015	2016.01	07/02/2015 03:53:46 PM Pacific Daylight Time	08/03/2015 12:09:50 PM Pacific Daylight Time	07/29/2015 01:42:24 PM Pacific Daylight Time			08/05/2015 03:13:42 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	2016	San Diego County		2	2000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	005	0	1	01	01	H5425_005_0	6		1	07/31/2015	2016.01	07/31/2015 01:11:57 PM Pacific Daylight Time	08/03/2015 02:56:54 PM Pacific Daylight Time	07/29/2015 01:42:38 PM Pacific Daylight Time			08/05/2015 03:13:42 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	2016	San Diego County		2	8000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	006	0	1	01	01	H5425_006_0	5		1	07/31/2015	2016.01	07/31/2015 12:58:41 PM Pacific Daylight Time	08/03/2015 12:11:40 PM Pacific Daylight Time	07/29/2015 01:42:52 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	006	0	2016	Los Angeles County		2	20600	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	007	0	1	01	01	H5425_007_0	5		1	07/31/2015	2016.01	07/31/2015 01:05:21 PM Pacific Daylight Time	08/03/2015 12:13:38 PM Pacific Daylight Time	07/29/2015 01:43:06 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	007	0	2016	Orange County		2	11000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	008	0	1	01	01	H5425_008_0	5		1	07/31/2015	2016.01	07/31/2015 01:07:26 PM Pacific Daylight Time	08/03/2015 03:14:32 PM Pacific Daylight Time	07/29/2015 01:58:08 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	008	0	2016	Riverside County		2	11000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	009	0	1	01	01	H5425_009_0	5		1	07/31/2015	2016.01	07/31/2015 01:09:23 PM Pacific Daylight Time	08/03/2015 03:23:10 PM Pacific Daylight Time	07/29/2015 01:43:46 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	009	0	2016	San Bernardino County		2	11000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	010	0	1	01	01	H5425_010_0	5	2	1	07/31/2015	2016.01	07/31/2015 01:01:19 PM Pacific Daylight Time	08/03/2015 12:28:20 PM Pacific Daylight Time	07/29/2015 01:44:12 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections (HMO SNP)	01	01		1			H5425	010	0	2016	Los Angeles, Riverside and San Bernardino Counties		2		2			1	3		1	5			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	019	0	1	01	01	H5425_019_0	6		1	07/02/2015	2016.01	07/02/2015 01:14:19 PM Pacific Daylight Time	08/03/2015 12:34:00 PM Pacific Daylight Time	07/29/2015 01:49:58 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	019	0	2016	San Francisco County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	020	0	1	01	01	H5425_020_0	5		1	07/02/2015	2016.01	07/02/2015 01:16:19 PM Pacific Daylight Time	08/03/2015 12:38:46 PM Pacific Daylight Time	07/29/2015 01:44:26 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	020	0	2016	Santa Clara County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	028	0	1	01	01	H5425_028_0	5		1	07/31/2015	2016.01	07/31/2015 01:05:54 PM Pacific Daylight Time	08/03/2015 12:43:24 PM Pacific Daylight Time	07/29/2015 01:44:38 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	028	0	2016	Orange County		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	029	0	1	01	01	H5425_029_0	5	2	1	07/31/2015	2016.01	07/31/2015 01:01:56 PM Pacific Daylight Time	08/03/2015 12:46:42 PM Pacific Daylight Time	07/29/2015 01:45:04 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO SNP)	01	01		1			H5425	029	0	2016	Los Angeles County		2		2			1	3		1	5			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	030	0	1	01	01	H5425_030_0	5	2	1	07/31/2015	2016.01	07/31/2015 01:08:50 PM Pacific Daylight Time	08/03/2015 12:48:48 PM Pacific Daylight Time	07/29/2015 01:45:28 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO SNP)	01	01		1			H5425	030	0	2016	Riverside County		2		2			1	3		1	5			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	031	0	1	01	01	H5425_031_0	5	2	1	07/31/2015	2016.01	07/31/2015 01:10:20 PM Pacific Daylight Time	08/03/2015 01:00:56 PM Pacific Daylight Time	07/29/2015 01:45:54 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO SNP)	01	01		1			H5425	031	0	2016	San Bernardino County		2		2			1	3		1	5			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	033	0	1	01	01	H5425_033_0	5		1	07/31/2015	2016.01	07/31/2015 01:08:18 PM Pacific Daylight Time	08/03/2015 01:03:22 PM Pacific Daylight Time	07/29/2015 01:46:06 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	033	0	2016	Riverside and San Bernardino Counties		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	034	0	1	01	01	H5425_034_0	5		1	07/31/2015	2016.01	07/31/2015 12:59:08 PM Pacific Daylight Time	08/03/2015 01:06:00 PM Pacific Daylight Time	07/29/2015 01:46:20 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	034	0	2016	Los Angeles and Orange Counties		2		2			1	4		1		00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	037	0	1	01	01	H5425_037_0	5		1	07/31/2015	2016.01	07/31/2015 01:06:58 PM Pacific Daylight Time	08/03/2015 01:08:02 PM Pacific Daylight Time	07/29/2015 01:46:48 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	01	01		1			H5425	037	0	2016	Orange County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	040	0	1	01	01	H5425_040_0	5		1	07/31/2015	2016.01	07/31/2015 01:13:06 PM Pacific Daylight Time	08/03/2015 01:17:14 PM Pacific Daylight Time	07/29/2015 01:47:14 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Plus offered by SCAN Health Plan (HMO)	01	01		1			H5425	040	0	2016	San Diego County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	045	0	1	01	01	H5425_045_0	5		1	07/31/2015	2016.01	07/31/2015 01:00:33 PM Pacific Daylight Time	08/03/2015 01:22:24 PM Pacific Daylight Time	07/29/2015 01:50:24 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	01	01		1			H5425	045	0	2016	Selected Southern and Northern CA Counties		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	046	0	1	01	01	H5425_046_0	6		1	07/02/2015	2016.01	07/02/2015 01:21:14 PM Pacific Daylight Time	08/03/2015 01:24:44 PM Pacific Daylight Time	07/29/2015 01:47:26 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	046	0	2016	Marin County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	047	0	1	01	01	H5425_047_0	5		1	07/02/2015	2016.01	07/02/2015 01:22:15 PM Pacific Daylight Time	08/03/2015 01:26:42 PM Pacific Daylight Time	07/29/2015 01:47:38 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	047	0	2016	Marin County		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	048	0	1	01	01	H5425_048_0	5		1	07/02/2015	2016.01	07/02/2015 01:23:34 PM Pacific Daylight Time	08/03/2015 01:31:20 PM Pacific Daylight Time	07/29/2015 01:47:52 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	048	0	2016	Marin County		2		2			1	4		1		00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	052	0	1	01	01	H5425_052_0	5		1	07/31/2015	2016.01	07/31/2015 01:15:06 PM Pacific Daylight Time	08/03/2015 01:33:18 PM Pacific Daylight Time	07/29/2015 01:48:04 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	052	0	2016	Napa and Sonoma Counties		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	053	0	1	01	01	H5425_053_0	5		1	07/02/2015	2016.01	07/02/2015 01:25:36 PM Pacific Daylight Time	08/03/2015 01:35:40 PM Pacific Daylight Time	07/29/2015 01:48:18 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	053	0	2016	Napa and Sonoma Counties		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	054	0	1	01	01	H5425_054_0	5		1	07/02/2015	2016.01	07/02/2015 01:26:48 PM Pacific Daylight Time	08/03/2015 01:38:16 PM Pacific Daylight Time	07/29/2015 01:48:30 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	054	0	2016	Napa and Sonoma Counties		2		2			1	4		1		00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	055	0	1	01	01	H5425_055_0	5		1	07/09/2015	2016.01	07/09/2015 11:53:48 AM Pacific Daylight Time	08/03/2015 01:41:30 PM Pacific Daylight Time	07/29/2015 01:48:42 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Heart First offered by SCAN Health Plan (HMO SNP)	01	01		1			H5425	055	0	2016	San Diego County		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	056	0	1	01	01	H5425_056_0	7		1	07/02/2015	2016.01	07/02/2015 01:29:20 PM Pacific Daylight Time	08/03/2015 01:43:50 PM Pacific Daylight Time	07/29/2015 01:48:54 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	056	0	2016	San Joaquin County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	057	0	1	01	01	H5425_057_0	5	2	1	07/31/2015	2016.01	07/31/2015 01:15:37 PM Pacific Daylight Time	08/03/2015 01:46:48 PM Pacific Daylight Time	07/29/2015 01:49:20 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections (HMO SNP)	01	01		1			H5425	057	0	2016	San Joaquin County		2		2			1	3		1	2			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	061	0	1	01	01	H5425_061_0	5		1	07/31/2015	2016.01	07/31/2015 01:07:48 PM Pacific Daylight Time	08/03/2015 03:17:48 PM Pacific Daylight Time	07/29/2015 01:49:32 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic II (HMO)	01	01		1			H5425	061	0	2016	Riverside County		2	11000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	062	0	1	01	01	H5425_062_0	5		1	07/31/2015	2016.01	07/31/2015 01:09:44 PM Pacific Daylight Time	08/03/2015 03:26:12 PM Pacific Daylight Time	07/29/2015 01:49:44 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic II (HMO)	01	01		1			H5425	062	0	2016	San Bernardino County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	801	0	1	01	01	H5425_801_0	2		1	04/28/2015	2016.01	04/28/2015 03:21:16 PM Pacific Daylight Time	05/30/2015 03:04:14 PM Pacific Daylight Time				05/30/2015 03:54:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Employer Group (HMO)	01	01		1			H5425	801	0	2016	Southern and Northern California Counties		1		2			2							www.scanhealthplan.com	http://www.scanhealthplan.com	http://www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5425	803	0	1	01	01	H5425_803_0	2		1	04/28/2015	2016.01	04/28/2015 03:21:30 PM Pacific Daylight Time	05/30/2015 03:14:28 PM Pacific Daylight Time				05/30/2015 03:54:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Employer Group (HMO)	01	01		1			H5425	803	0	2016	Southern and Northern California Counties		1		2			2							www.scanhealthplan.com	http://www.scanhealthplan.com	http://www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	804	0	1	01	01	H5425_804_0	2		1	04/28/2015	2016.01	04/28/2015 03:22:40 PM Pacific Daylight Time	05/30/2015 03:07:22 PM Pacific Daylight Time				05/30/2015 03:54:13 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Employer Group (HMO)	01	01		1			H5425	804	0	2016	Southern and Northern California Counties		1		2			2							www.scanhealthplan.com	http://www.scanhealthplan.com	http://www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	052	0	1	01	01	H5427_052_0	5		1	07/07/2015	2016.01	07/07/2015 09:02:51 AM Eastern Daylight Time	05/28/2015 11:31:18 AM Eastern Daylight Time				07/09/2015 11:58:18 AM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Savings Plan (HMO)	01	01		1			H5427	052	0	2016	Select Counties in Florida		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5427	059	0	1	01	01	H5427_059_0	6		1	08/05/2015	2016.01	08/05/2015 07:56:56 AM Eastern Daylight Time	08/05/2015 09:51:48 AM Eastern Daylight Time	08/04/2015 07:22:14 PM Eastern Daylight Time			08/05/2015 05:20:58 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	059	0	2016	Select Counties in Florida		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	060	0	1	01	01	H5427_060_0	6		1	08/05/2015	2016.01	08/05/2015 07:57:32 AM Eastern Daylight Time	08/05/2015 09:53:02 AM Eastern Daylight Time	08/04/2015 07:23:10 PM Eastern Daylight Time			08/05/2015 05:20:58 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	060	0	2016	Select Counties in Florida		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	070	0	1	01	01	H5427_070_0	5		1	08/05/2015	2016.01	08/05/2015 07:58:41 AM Eastern Daylight Time	08/05/2015 09:54:54 AM Eastern Daylight Time	08/04/2015 07:24:34 PM Eastern Daylight Time			08/05/2015 05:20:58 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Care (HMO SNP)	01	01		1			H5427	070	0	2016	Select Counties in Florida		2	0	2			1	4		1		00000000000000000010		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	072	0	1	01	01	H5427_072_0	5		1	08/05/2015	2016.01	08/05/2015 03:38:55 PM Eastern Daylight Time	08/05/2015 10:11:16 AM Eastern Daylight Time	08/04/2015 07:25:48 PM Eastern Daylight Time			08/05/2015 05:20:58 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings (HMO SNP)	01	01		1			H5427	072	0	2016	Select Counties in Florida		2	0	2			1	4		1		00000000000000000010		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	077	0	1	01	01	H5427_077_0	5		1	08/05/2015	2016.01	08/05/2015 07:59:01 AM Eastern Daylight Time	08/05/2015 10:12:36 AM Eastern Daylight Time	08/04/2015 07:26:48 PM Eastern Daylight Time			08/05/2015 05:20:58 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO SNP)	01	01		1			H5427	077	0	2016	Select Counties in Florida		2	0	2			1	4		1		00000000000100000000		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	078	0	1	01	01	H5427_078_0	5	2	1	08/05/2015	2016.01	08/05/2015 07:58:25 AM Eastern Daylight Time	08/05/2015 10:13:54 AM Eastern Daylight Time	08/04/2015 07:28:00 PM Eastern Daylight Time			08/05/2015 05:20:58 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medi-Medi Partial (HMO SNP)	01	01		1			H5427	078	0	2016	Select Counties in Florida		2	0	2			1	3		1	4			http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	082	0	1	01	01	H5427_082_0	6		1	08/05/2015	2016.01	08/05/2015 07:59:52 AM Eastern Daylight Time	08/05/2015 10:15:16 AM Eastern Daylight Time	08/04/2015 07:28:58 PM Eastern Daylight Time			08/05/2015 05:20:58 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings (HMO SNP)	01	01		1			H5427	082	0	2016	Select Counties in Florida		2	0	2			1	4		1		00000000000000000010		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	083	0	1	01	01	H5427_083_0	6		1	08/05/2015	2016.01	08/05/2015 07:59:44 AM Eastern Daylight Time	08/05/2015 10:25:36 AM Eastern Daylight Time	08/04/2015 07:30:10 PM Eastern Daylight Time			08/05/2015 05:20:58 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO SNP)	01	01		1			H5427	083	0	2016	Select Counties in Florida		2	0	2			1	4		1		00000000000100000000		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	087	0	1	01	01	H5427_087_0	5	2	1	08/05/2015	2016.01	08/05/2015 04:17:55 PM Eastern Daylight Time	08/05/2015 10:34:26 AM Eastern Daylight Time	08/04/2015 07:31:12 PM Eastern Daylight Time			08/05/2015 05:20:58 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medi-Medi Full (HMO SNP)	01	01		1			H5427	087	0	2016	Select Counties in Florida		2	0	2			1	3		1	5			http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	088	0	1	01	01	H5427_088_0	5		1	08/05/2015	2016.01	08/05/2015 07:57:12 AM Eastern Daylight Time	08/05/2015 10:35:52 AM Eastern Daylight Time	08/04/2015 07:32:10 PM Eastern Daylight Time			08/05/2015 05:20:58 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	2016	select counties in Florida		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	089	0	1	01	01	H5427_089_0	5		1	08/05/2015	2016.01	08/05/2015 03:39:17 PM Eastern Daylight Time	08/05/2015 10:37:44 AM Eastern Daylight Time	08/04/2015 07:33:10 PM Eastern Daylight Time			08/05/2015 05:20:58 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	2016	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	091	0	1	01	01	H5427_091_0	5		1	08/05/2015	2016.01	08/05/2015 03:39:29 PM Eastern Daylight Time	08/05/2015 10:39:26 AM Eastern Daylight Time	08/04/2015 07:34:10 PM Eastern Daylight Time			08/05/2015 05:20:58 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	2016	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	092	0	1	01	01	H5427_092_0	5		1	08/05/2015	2016.01	08/05/2015 03:39:48 PM Eastern Daylight Time	08/05/2015 10:41:30 AM Eastern Daylight Time	08/04/2015 07:35:24 PM Eastern Daylight Time			08/05/2015 05:20:58 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	2016	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	093	0	1	01	01	H5427_093_0	5		1	08/05/2015	2016.01	08/05/2015 03:39:56 PM Eastern Daylight Time	08/05/2015 10:42:52 AM Eastern Daylight Time	08/04/2015 07:36:24 PM Eastern Daylight Time			08/05/2015 05:20:58 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	2016	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	094	0	1	01	01	H5427_094_0	5		1	08/05/2015	2016.01	08/05/2015 03:40:05 PM Eastern Daylight Time	08/05/2015 10:43:50 AM Eastern Daylight Time	08/04/2015 07:37:20 PM Eastern Daylight Time			08/05/2015 05:20:58 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	2016	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5428	001	0	1	01	01	H5428_001_0	4	2	1	07/01/2015	2016.01	07/01/2015 09:49:49 AM Pacific Daylight Time	07/30/2015 12:49:52 PM Pacific Daylight Time	07/30/2015 12:50:17 PM Pacific Daylight Time			08/04/2015 04:11:12 PM Pacific Daylight Time	SAN MATEO HEALTH COMMISSION	Health Plan of San Mateo	www.hpsm.org	CareAdvantage (HMO SNP)	01	01		1			H5428	001	0	2016	San Mateo County		2	750	2			1	3		1	5			www.hpsm.org	http://www.hpsm.org/Members.aspx/139.htm	http://www.hpsm.org/Members.aspx/139.htm	(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			
H5430	001	0	1	01	01	H5430_001_0	6	2	1	08/03/2015	2016.01	08/03/2015 05:10:48 PM US Mountain Standard Time	08/03/2015 01:26:43 PM US Mountain Standard Time	08/03/2015 01:34:33 PM US Mountain Standard Time			08/03/2015 05:13:30 PM US Mountain Standard Time	ONECARE BY CARE1ST HEALTH PLAN ARIZONA INC.	Care1st+	www.care1st.com/az/medicare	Care1st+ (HMO SNP)	01	01		1			H5430	001	0	2016	Counties:  Maricopa and Pima		2	1750	2			1	3		1	4			http://www.care1st.com/az/healthplans/onecare_medicare_directory.asp	https://www.care1st.com/az/medicare	https://www.care1st.com/az/medicare	(877)778-1855		(602)778-8345		(877)778-1855		(602)778-8345		(877)778-1855		(602)778-8345		(877)778-1855		(602)778-8345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5431	001	0	1	01	01	H5431_001_0	5		1	07/22/2015	2016.01	07/22/2015 09:57:34 AM Eastern Daylight Time	08/05/2015 04:07:48 PM Eastern Daylight Time	08/05/2015 04:45:39 PM Eastern Daylight Time			08/05/2015 05:34:02 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.healthsun.com	HealthSun SunPlus Advantage Plan (HMO)	01	01		1			H5431	001	0	2016	Miami-Dade		2	2945	2			2								www.healthsun.com	www.healthsun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(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			
H5431	006	0	1	01	01	H5431_006_0	6		1	07/22/2015	2016.01	07/22/2015 09:57:42 AM Eastern Daylight Time	08/05/2015 04:08:52 PM Eastern Daylight Time	08/05/2015 04:46:23 PM Eastern Daylight Time			08/05/2015 05:34:02 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.healthsun.com	HealthSun MediMax (HMO)	01	01		1			H5431	006	0	2016	Broward and Miami-Dade		2	2945	2			2								www.healthsun.com	www.healthsun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(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			
H5431	011	0	1	02	01	H5431_011_0	6		1	07/22/2015	2016.01	07/22/2015 09:57:48 AM Eastern Daylight Time	08/05/2015 04:09:55 PM Eastern Daylight Time	08/05/2015 04:47:07 PM Eastern Daylight Time			08/05/2015 05:34:02 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.healthsun.com	HealthSun SunPlus Advantage POS (HMO-POS)	01	02		1			H5431	011	0	2016	Miami-Dade		2	2000	2			2								www.healthsun.com	www.healthsun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(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			
H5431	012	0	1	01	01	H5431_012_0	6		1	09/10/2015	2016.01	09/10/2015 10:11:25 AM Eastern Daylight Time	08/05/2015 04:11:06 PM Eastern Daylight Time	08/05/2015 04:47:50 PM Eastern Daylight Time			09/10/2015 10:13:35 AM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.healthsun.com	HealthSun HealthAdvantage Plan (HMO)	01	01		1			H5431	012	0	2016	Broward County		2	279	2			2								www.healthsun.com	www.healthsun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(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	1	01	7d;	
H5433	001	0	1	01	01	H5433_001_0	8	2	1	08/04/2015	2016.01	08/04/2015 02:02:36 PM Pacific Daylight Time	08/04/2015 01:57:33 PM Pacific Daylight Time	08/04/2015 01:57:34 PM Pacific Daylight Time			08/04/2015 02:05:30 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	OneCare	www.caloptima.org/onecare	OneCare (HMO SNP)	01	01		1			H5433	001	0	2016	Orange County		2	1445	2			1	3		1	5			www.caloptima.org/onecare	https://www.caloptima.org/en/Members/OneCare/MedicarePartD.aspx	www.caloptima.org/onecare	(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2	2			
H5434	002	0	1	04	01	H5434_002_0	6		1	07/24/2015	2016.01	07/24/2015 09:27:53 AM Eastern Daylight Time	08/03/2015 12:35:55 PM Eastern Daylight Time	07/29/2015 04:28:54 PM Eastern Daylight Time			08/04/2015 04:27:35 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare PPO (PPO)	01	04		1			H5434	002	0	2016	Select counties in S.FL/ W.FL/C.FL,N.C. FL/N.W FL		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(855)573-5893		(855)573-5893		(855)601-9465		(855)601-9465		(855)573-5893		(855)573-5893		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2						2			
H5434	801	0	1	04	01	H5434_801_0	2		1	06/01/2015	2016.01	06/01/2015 11:08:44 AM Eastern Daylight Time	06/01/2015 06:36:40 PM Eastern Daylight Time				06/01/2015 07:46:23 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Group PPO (PPO)	01	04		1			H5434	801	0	2016	State of Florida with National Coverage		1		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		1	1	1a;1b;2;5;7c;7i;8a;8b1;8b2;8b3;9c;11a;	2		1						2			
H5434	802	0	1	04	01	H5434_802_0	2		1	06/01/2015	2016.01	06/01/2015 01:05:46 PM Eastern Daylight Time	06/01/2015 06:37:23 PM Eastern Daylight Time				06/01/2015 07:46:23 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Group PPO (PPO)	01	04		1			H5434	802	0	2016	State of Florida with National Coverage		1		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		1	1	1a;1b;2;5;7c;7i;8a;8b1;8b2;8b3;9c;11a;	2		1						2			
H5435	001	0	1	09	04	H5435_001_0	1		1	05/22/2015	2016.01	05/22/2015 09:23:33 AM Central Daylight Time	05/29/2015 02:33:41 PM Central Daylight Time				05/30/2015 05:04:29 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Essential (PFFS)	04	09	2	1			H5435	001	0	2016	Select counties nationwide		2		2			2								www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)579-8774		(866)579-8774		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2										2	2			
H5435	024	0	1	09	04	H5435_024_0	2		1	05/29/2015	2016.01	05/29/2015 09:56:04 AM Central Daylight Time	07/31/2015 12:49:25 PM Central Daylight Time	07/30/2015 10:39:02 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Rx (PFFS)	04	09	2	1			H5435	024	0	2016	Select counties nationwide		2		2			2								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	005	0	1	04	01	H5439_005_0	4		1	07/30/2015	2016.01	07/30/2015 11:40:50 AM Pacific Daylight Time	08/03/2015 08:46:38 AM Pacific Daylight Time	07/29/2015 05:00:48 PM Pacific Daylight Time			08/03/2015 05:42:22 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet (PPO)	01	04		1			H5439	005	0	2016	San Francisco, CA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	007	0	1	04	01	H5439_007_0	5		1	07/09/2015	2016.01	07/09/2015 03:25:14 PM Pacific Daylight Time	08/03/2015 09:58:40 AM Pacific Daylight Time	07/29/2015 05:00:58 PM Pacific Daylight Time			08/03/2015 05:42:22 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet (PPO)	01	04		1			H5439	007	0	2016	Yolo County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5439	801	0	1	04	01	H5439_801_0	3		1	06/01/2015	2016.01	06/01/2015 10:01:58 AM Pacific Daylight Time	05/28/2015 08:32:10 PM Pacific Daylight Time				06/01/2015 10:22:42 AM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	801	0	2016	Placer, Sac, S.D., S.F., S. Joaquin, Stan., Yolo		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H5439	802	0	1	04	01	H5439_802_0	3		1	06/01/2015	2016.01	06/01/2015 10:02:07 AM Pacific Daylight Time	05/28/2015 08:32:42 PM Pacific Daylight Time				06/01/2015 10:22:42 AM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	802	0	2016	Placer, Sac, S.D., S.F., S. Joaquin, Stan., Yolo		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H5439	803	0	1	04	01	H5439_803_0	3		1	06/01/2015	2016.01	06/01/2015 10:02:13 AM Pacific Daylight Time	05/28/2015 08:33:12 PM Pacific Daylight Time				06/01/2015 10:22:42 AM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	803	0	2016	Placer, Sac, S.D., S.F., S. Joaquin, Stan., Yolo		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H5441	001	0	1	48	05	H5441_001_0	3		1	08/09/2015	2016.01	08/09/2015 09:50:52 PM Eastern Daylight Time					08/10/2015 11:18:28 AM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H5441	001	0	2016	Counties: Ki, Qu, Brx, NY, Rich, Wes, and Na		2	10000	2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H5471	001	0	1	01	01	H5471_001_0	5	2	1	08/05/2015	2016.01	08/05/2015 02:09:54 PM Eastern Daylight Time	08/04/2015 09:59:26 PM Eastern Daylight Time	08/04/2015 10:20:14 PM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	001	0	2016	Miami-Dade County		2	12265	2			1	3		1	4			www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	002	0	1	01	01	H5471_002_0	5		1	08/05/2015	2016.01	08/05/2015 11:07:07 AM Eastern Daylight Time	08/04/2015 10:01:10 PM Eastern Daylight Time	08/04/2015 10:26:39 PM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	002	0	2016	Miami-Dade County		2	8432	2			2							www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	004	0	1	01	01	H5471_004_0	5		1	07/07/2015	2016.01	07/07/2015 11:49:27 AM Eastern Daylight Time	08/04/2015 10:02:10 PM Eastern Daylight Time	08/04/2015 10:28:37 PM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Extra (HMO)	01	01		1			H5471	004	0	2016	Miami-Dade County		2	689	2			2							www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	007	0	1	01	01	H5471_007_0	5	2	1	08/05/2015	2016.01	08/05/2015 11:06:54 AM Eastern Daylight Time	08/04/2015 10:04:13 PM Eastern Daylight Time	08/04/2015 10:30:10 PM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	007	0	2016	Polk County		2	3201	2			1	3		1	4			www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	008	0	1	01	01	H5471_008_0	5		1	08/05/2015	2016.01	08/05/2015 11:08:02 AM Eastern Daylight Time	08/04/2015 10:06:06 PM Eastern Daylight Time	08/04/2015 10:31:53 PM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Care (HMO SNP)	01	01		1			H5471	008	0	2016	Miami-Dade County		2	65	2			1	1	1	1				www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	009	0	1	01	01	H5471_009_0	5		1	08/05/2015	2016.01	08/05/2015 02:19:06 PM Eastern Daylight Time	08/04/2015 10:06:47 PM Eastern Daylight Time	08/05/2015 12:22:16 AM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Comfort (HMO SNP)	01	01		1			H5471	009	0	2016	Miami-Dade County		2	327	2			1	1	2	1				www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	012	0	1	01	01	H5471_012_0	5		1	08/05/2015	2016.01	08/05/2015 11:08:38 AM Eastern Daylight Time	08/04/2015 10:07:35 PM Eastern Daylight Time	08/05/2015 12:22:39 AM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	012	0	2016	Miami-Dade County		2	657	2			1	4		1		00000010000000000000		www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	020	0	1	01	01	H5471_020_0	6		1	08/05/2015	2016.01	08/05/2015 11:09:04 AM Eastern Daylight Time	08/04/2015 10:08:54 PM Eastern Daylight Time	08/05/2015 12:23:27 AM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	020	0	2016	Polk County		2	812	2			1	4		1		00000010000000000000		www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	021	0	1	01	01	H5471_021_0	5		1	08/05/2015	2016.01	08/05/2015 11:10:39 AM Eastern Daylight Time	08/04/2015 10:10:04 PM Eastern Daylight Time	08/05/2015 12:24:39 AM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	021	0	2016	Polk County		2	1468	2			2							www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	039	0	1	01	01	H5471_039_0	5	2	1	08/05/2015	2016.01	08/05/2015 11:12:07 AM Eastern Daylight Time	08/04/2015 10:11:45 PM Eastern Daylight Time	08/05/2015 12:25:02 AM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	039	0	2016	Orange Osceola Seminole Counties		2	1796	2			1	3		1	4			www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	042	0	1	01	01	H5471_042_0	5		1	08/05/2015	2016.01	08/05/2015 11:12:36 AM Eastern Daylight Time	08/04/2015 10:12:56 PM Eastern Daylight Time	08/05/2015 12:25:19 AM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	042	0	2016	Orange Osceola Seminole Counties		2	219	2			1	4		1		00000010000000000000		www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	043	0	1	01	01	H5471_043_0	5		1	08/05/2015	2016.01	08/05/2015 11:13:14 AM Eastern Daylight Time	08/04/2015 10:13:55 PM Eastern Daylight Time	08/05/2015 12:25:40 AM Eastern Daylight Time			08/06/2015 10:32:30 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	043	0	2016	Orange Osceola Seminole Counties		2	1330	2			2							www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	001	0	1	01	01	H5475_001_0	7	2	1	07/20/2015	2016.01	07/20/2015 10:52:52 AM Eastern Daylight Time	08/03/2015 12:15:30 PM Eastern Daylight Time	07/30/2015 04:11:00 PM Eastern Daylight Time			08/05/2015 06:47:30 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Advantage Plan of Michigan (HMO SNP)	01	01		1			H5475	001	0	2016	Southern Michigan and Northern Ohio		2		2			1	3		1	5			www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	002	0	1	01	01	H5475_002_0	6		1	08/05/2015	2016.01	08/05/2015 03:11:23 PM Eastern Daylight Time	08/03/2015 12:16:18 PM Eastern Daylight Time	07/30/2015 04:12:18 PM Eastern Daylight Time			08/05/2015 06:42:18 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Prime (HMO)	01	01		1			H5475	002	0	2016	Southern Michigan and Northern Ohio		2		2			2							www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5493	001	0	1	20	08	H5493_001_0	1		1	05/27/2015	2016.01	05/27/2015 12:04:55 PM Mountain Daylight Time		05/27/2015 07:53:46 AM Mountain Daylight Time			05/27/2015 12:06:42 PM Mountain Daylight Time	LIFE AT ST. FRANCIS HEALTHCARE, INC.	St. Francis LIFE	www.stfrancishealthcare.org	LIFE at St. Francis Healthcare, Inc (PACE)	08	20		1			H5493	001	0	2016	LIFE at St. Francis Healthcare, Inc		2		2			2								www.stfrancishealthcare.org	www.stfrancishealthcare.org									(800)000-0000		(302)575-8240		(800)000-0000		(302)575-8240										(800)000-0000		(302)575-8240		(800)000-0000		(302)575-8240																
H5493	002	0	1	20	08	H5493_002_0	1		1	05/27/2015	2016.01	05/27/2015 12:05:13 PM Mountain Daylight Time		05/27/2015 07:55:02 AM Mountain Daylight Time			05/27/2015 12:06:42 PM Mountain Daylight Time	LIFE AT ST. FRANCIS HEALTHCARE, INC.	St. Francis LIFE	www.stfrancishealthcare.org	LIFE at St. Francis Healthcare, Inc (PACE)	08	20		1			H5493	002	0	2016	LIFE at St. Francis Healthcare, Inc		2		2			2								www.stfrancishealthcare.org	www.stfrancishealthcare.org									(800)000-0000		(302)575-8240		(800)000-0000		(302)575-8240										(800)000-0000		(302)575-8240		(800)000-0000		(302)575-8240																
H5508	001	0	1	04	01	H5508_001_0	7		1	07/21/2015	2016.01	07/21/2015 02:56:34 PM Eastern Daylight Time	08/04/2015 07:09:39 PM Eastern Daylight Time	07/30/2015 04:40:58 PM Eastern Daylight Time			08/05/2015 04:02:53 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Enhanced (PPO)	01	04		1			H5508	001	0	2016	Central and Northern Indiana		2	2859	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950		(877)684-0014	1	(317)573-7950	1	(800)201-8342		(317)573-7950		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2						2			
H5508	002	0	1	04	01	H5508_002_0	4		1	07/10/2015	2016.01	07/10/2015 02:45:07 PM Eastern Daylight Time	05/28/2015 11:53:04 PM Eastern Daylight Time				07/12/2015 12:48:23 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Preferred (PPO)	01	04		1			H5508	002	0	2016	Central and Northern Indiana		2	1150	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2						2			
H5508	005	0	1	04	01	H5508_005_0	7		1	07/10/2015	2016.01	07/10/2015 02:18:01 PM Eastern Daylight Time	08/04/2015 12:44:31 PM Eastern Daylight Time	07/30/2015 04:41:49 PM Eastern Daylight Time			08/05/2015 04:02:53 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Select (PPO)	01	04		1			H5508	005	0	2016	Central and Northern Indiana		2	16524	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950		(877)684-0014	1	(317)573-7950	1	(800)201-8342		(317)573-7950		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2						2			
H5508	006	0	1	04	01	H5508_006_0	5		1	08/05/2015	2016.01	08/05/2015 11:39:41 AM Eastern Daylight Time	08/04/2015 12:37:07 PM Eastern Daylight Time	07/30/2015 04:43:21 PM Eastern Daylight Time			08/05/2015 04:02:53 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Choice (PPO)	01	04		1			H5508	006	0	2016	Central and Northern Indiana		2	2377	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950		(877)684-0014	1	(317)573-7950	1	(800)201-8342		(317)573-7950		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2						2			
H5508	801	0	1	04	01	H5508_801_0	2		1	05/29/2015	2016.01	05/29/2015 02:40:37 PM Eastern Daylight Time	05/28/2015 11:54:40 PM Eastern Daylight Time				05/29/2015 02:42:03 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Select Plus Group (PPO)	01	04		1			H5508	801	0	2016	Indiana		1	100	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950		(877)684-0014	1	(317)573-7950	1	(800)201-8342		(317)573-7950		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(866)763-9630		(866)763-9630		(800)743-3333		(800)743-3333		2					2						2			
H5508	802	0	1	04	01	H5508_802_0	1		1	05/20/2015	2016.01	05/20/2015 09:02:51 AM Eastern Daylight Time	05/28/2015 11:55:16 PM Eastern Daylight Time				05/29/2015 11:24:46 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Preferred Group (PPO)	01	04		1			H5508	802	0	2016	Indiana		1	100	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2						2			
H5508	803	0	1	04	01	H5508_803_0	1		1	05/19/2015	2016.01	05/19/2015 04:41:57 PM Eastern Daylight Time	05/28/2015 11:55:48 PM Eastern Daylight Time				05/29/2015 11:26:17 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Select Group (PPO)	01	04		1			H5508	803	0	2016	Indiana		1	100	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2						2			
H5508	804	0	1	04	01	H5508_804_0	1		1	05/20/2015	2016.01	05/20/2015 09:03:11 AM Eastern Daylight Time	05/28/2015 11:56:26 PM Eastern Daylight Time				05/29/2015 11:27:57 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Preferred Plus Group (PPO)	01	04		1			H5508	804	0	2016	Indiana		1	100	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950		(877)684-0014	1	(317)573-7950	1	(800)201-8342		(317)573-7950		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(866)763-9630		(866)763-9630		(800)743-3333		(800)743-3333		2					2						2			
H5520	001	0	1	04	01	H5520_001_0	2		1	07/09/2015	2016.01	07/09/2015 03:45:39 PM Pacific Daylight Time	07/14/2015 08:08:20 AM Pacific Daylight Time				07/14/2015 04:14:59 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Aqua (PPO)	01	04		1			H5520	001	0	2016	Portland, Salem, MidVly OR and Clark WA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5520	002	0	1	04	01	H5520_002_0	3		1	07/30/2015	2016.01	07/30/2015 10:39:09 AM Pacific Daylight Time	08/03/2015 01:24:15 PM Pacific Daylight Time	08/03/2015 01:24:15 PM Pacific Daylight Time			08/03/2015 02:28:29 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 1 (PPO)	01	04		1			H5520	002	0	2016	Portland, Salem, MidVly, OR and Clark WA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5520	003	0	1	04	01	H5520_003_0	2		1	07/09/2015	2016.01	07/09/2015 03:46:06 PM Pacific Daylight Time	07/14/2015 08:08:20 AM Pacific Daylight Time				07/14/2015 04:14:59 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Aqua (PPO)	01	04		1			H5520	003	0	2016	Douglas, Jackson and Josephine Counties, OR		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5520	004	0	1	04	01	H5520_004_0	6		1	08/04/2015	2016.01	08/04/2015 10:36:50 AM Pacific Daylight Time	08/03/2015 01:24:16 PM Pacific Daylight Time	08/03/2015 01:24:16 PM Pacific Daylight Time			08/04/2015 10:45:21 AM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 1 (PPO)	01	04		1			H5520	004	0	2016	Douglas, Jackson and Josephine Counties, OR		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5520	012	1	1	04	01	H5520_012_1	3		1	07/30/2015	2016.01	07/30/2015 10:34:12 AM Pacific Daylight Time	08/03/2015 01:24:16 PM Pacific Daylight Time	08/03/2015 01:24:17 PM Pacific Daylight Time			08/03/2015 02:28:29 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	012	1	2016	Portland, Salem, MidVly OR and Clark WA	OR Counties: CK, LA, ML, WA.  WA Counties: CR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5520	012	2	1	04	01	H5520_012_2	3		1	07/30/2015	2016.01	08/03/2015 02:07:50 PM Pacific Daylight Time	08/03/2015 01:24:17 PM Pacific Daylight Time	08/03/2015 01:24:18 PM Pacific Daylight Time			08/03/2015 02:28:29 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	012	2	2016	Portland, Salem, MidVly OR and Clark WA	Benton, Linn and Yamhill Counties, OR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5520	012	3	1	04	01	H5520_012_3	4		1	07/30/2015	2016.01	08/03/2015 02:07:51 PM Pacific Daylight Time	08/03/2015 01:24:18 PM Pacific Daylight Time	08/03/2015 01:24:18 PM Pacific Daylight Time			08/03/2015 02:28:29 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	012	3	2016	Portland, Salem, MidVly OR and Clark WA	Marion and Polk Counties, OR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5520	012	4	1	04	01	H5520_012_4	3		1	07/30/2015	2016.01	08/03/2015 02:07:51 PM Pacific Daylight Time	08/03/2015 01:24:19 PM Pacific Daylight Time	08/03/2015 01:24:19 PM Pacific Daylight Time			08/03/2015 02:28:29 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	012	4	2016	Portland, Salem, MidVly OR and Clark WA	Clark, WA	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5520	014	0	1	04	01	H5520_014_0	5		1	08/04/2015	2016.01	08/04/2015 10:31:17 AM Pacific Daylight Time	08/03/2015 01:24:20 PM Pacific Daylight Time	08/03/2015 01:24:20 PM Pacific Daylight Time			08/04/2015 10:45:21 AM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 3 (PPO)	01	04		1			H5520	014	0	2016	Douglas and Josephine Counties, OR		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5520	015	1	1	04	01	H5520_015_1	5		1	07/15/2015	2016.01	07/15/2015 05:04:12 PM Pacific Daylight Time	08/03/2015 01:24:20 PM Pacific Daylight Time	08/03/2015 01:24:21 PM Pacific Daylight Time			08/03/2015 02:28:29 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	015	1	2016	Douglas, Jackson and Josephine Counties, OR	Jackson County, OR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5520	015	2	1	04	01	H5520_015_2	5		1	07/15/2015	2016.01	07/15/2015 05:04:50 PM Pacific Daylight Time	08/03/2015 01:24:21 PM Pacific Daylight Time	08/03/2015 01:24:14 PM Pacific Daylight Time			08/03/2015 02:28:29 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	015	2	2016	Douglas, Jackson and Josephine Counties, OR	Douglas and Josephine Counties, OR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5520	807	0	1	04	01	H5520_807_0	2		1	04/29/2015	2016.01	04/29/2015 03:22:44 PM US Mountain Standard Time	05/29/2015 10:09:29 AM Pacific Daylight Time				05/30/2015 02:18:50 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Aqua Employer (PPO)	01	04		1			H5520	807	0	2016	Ptld, Salem, MdVly, Doug, Jkson, Josephine, Clark		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H5520	808	0	1	04	01	H5520_808_0	2		1	04/29/2015	2016.01	04/29/2015 03:22:54 PM US Mountain Standard Time	05/29/2015 10:09:31 AM Pacific Daylight Time				05/30/2015 02:18:50 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Employer (PPO)	01	04		1			H5520	808	0	2016	Ptld, Salem, MdVly, Doug, Jkson, Josephine, Clark		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H5520	809	0	1	04	01	H5520_809_0	2		1	04/29/2015	2016.01	04/29/2015 03:23:05 PM US Mountain Standard Time	05/29/2015 10:09:34 AM Pacific Daylight Time				05/30/2015 02:18:50 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Employer (PPO)	01	04		1			H5520	809	0	2016	Ptld, Salem, MdVly, Doug, Jkson, Josephine, Clark		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H5521	012	0	1	04	01	H5521_012_0	10		1	08/03/2015	2016.01	08/03/2015 01:45:21 PM Eastern Daylight Time	08/02/2015 10:52:54 AM Eastern Daylight Time	07/29/2015 05:36:21 PM Eastern Daylight Time			08/03/2015 01:49:31 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	012	0	2016	Central and NE PA		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	013	0	1	04	01	H5521_013_0	4		1	07/07/2015	2016.01	07/07/2015 11:07:00 AM Eastern Daylight Time	08/01/2015 10:05:56 AM Eastern Daylight Time	07/29/2015 05:36:40 PM Eastern Daylight Time			08/02/2015 07:12:03 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	013	0	2016	Connecticut		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	015	0	1	04	01	H5521_015_0	7		1	05/28/2015	2016.01	05/28/2015 07:24:21 PM Eastern Daylight Time	07/30/2015 03:49:23 PM Eastern Daylight Time	07/29/2015 05:36:59 PM Eastern Daylight Time			07/31/2015 09:21:48 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	015	0	2016	District of Columbia		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	016	0	1	04	01	H5521_016_0	5		1	07/31/2015	2016.01	07/31/2015 09:58:40 PM Eastern Daylight Time	07/31/2015 07:48:02 PM Eastern Daylight Time	07/29/2015 05:37:18 PM Eastern Daylight Time			08/01/2015 11:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	016	0	2016	Cook County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	020	0	1	04	01	H5521_020_0	6		1	06/09/2015	2016.01	06/09/2015 11:06:12 AM Eastern Daylight Time	08/02/2015 09:03:04 PM Eastern Daylight Time	07/29/2015 05:37:37 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	020	0	2016	Ohio and Northern Kentucky		2	1063	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	022	0	1	04	01	H5521_022_0	8		1	07/31/2015	2016.01	07/31/2015 10:03:01 PM Pacific Daylight Time	08/02/2015 07:14:05 PM Eastern Daylight Time	07/29/2015 05:37:57 PM Eastern Daylight Time			08/03/2015 09:28:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	022	0	2016	Clark County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	027	0	1	04	01	H5521_027_0	6		1	05/28/2015	2016.01	05/28/2015 12:33:36 PM Eastern Daylight Time	07/30/2015 04:27:34 PM Eastern Daylight Time	07/29/2015 05:38:16 PM Eastern Daylight Time			07/31/2015 09:21:48 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Innovation Choice Plan (PPO)	01	04		1			H5521	027	0	2016	Fairfax County and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	033	0	1	04	01	H5521_033_0	7		1	07/31/2015	2016.01	07/31/2015 06:33:29 PM Eastern Daylight Time	07/31/2015 04:08:37 PM Eastern Daylight Time	07/29/2015 05:38:35 PM Eastern Daylight Time			08/02/2015 10:59:55 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	033	0	2016	South FL, Southwest FL, Central FL, North FL		2		2			2							www.aetnamedicare.com	www.aetnamedicare.com	www.aetnamedicare.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	037	0	1	04	01	H5521_037_0	6		1	08/05/2015	2016.01	08/05/2015 04:27:07 PM Eastern Daylight Time	08/01/2015 06:53:56 AM Eastern Daylight Time	07/29/2015 05:38:54 PM Eastern Daylight Time			08/05/2015 04:44:51 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	037	0	2016	Northern NJ		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	040	0	1	04	01	H5521_040_0	4		1	07/16/2015	2016.01	07/16/2015 06:50:05 PM Eastern Daylight Time	08/01/2015 09:59:30 AM Eastern Daylight Time	07/29/2015 05:39:13 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	040	0	2016	New York		2	2168	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	052	0	1	04	01	H5521_052_0	13		1	07/15/2015	2016.01	07/15/2015 03:31:43 PM Eastern Daylight Time	08/03/2015 09:38:39 AM Eastern Daylight Time	07/29/2015 05:39:33 PM Eastern Daylight Time			08/03/2015 09:59:23 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Connect Plus (PPO)	01	04		1			H5521	052	0	2016	National		2	14309	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	053	0	1	04	01	H5521_053_0	6		1	05/27/2015	2016.01	05/27/2015 10:39:16 AM Pacific Daylight Time	08/04/2015 09:58:48 AM Eastern Daylight Time	07/29/2015 05:39:52 PM Eastern Daylight Time			08/04/2015 03:54:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	053	0	2016	San Diego		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	055	0	1	04	01	H5521_055_0	7		1	07/15/2015	2016.01	07/15/2015 09:19:01 AM Pacific Daylight Time	08/04/2015 12:22:44 PM Eastern Daylight Time	07/29/2015 05:40:11 PM Eastern Daylight Time			08/04/2015 03:54:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	055	0	2016	Clark County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	056	0	1	04	01	H5521_056_0	6		1	05/27/2015	2016.01	05/27/2015 10:39:35 AM Pacific Daylight Time	08/04/2015 10:02:07 AM Eastern Daylight Time	07/29/2015 05:40:30 PM Eastern Daylight Time			08/04/2015 03:54:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	056	0	2016	Orange County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	057	0	1	04	01	H5521_057_0	8		1	07/15/2015	2016.01	07/15/2015 09:19:37 AM Pacific Daylight Time	08/04/2015 11:34:12 AM Eastern Daylight Time	07/29/2015 05:40:49 PM Eastern Daylight Time			08/04/2015 03:54:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (PPO)	01	04		1			H5521	057	0	2016	Denver and Surrounding Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	058	0	1	04	01	H5521_058_0	4		1	08/01/2015	2016.01	08/01/2015 08:00:00 AM Central Daylight Time	08/02/2015 06:37:52 PM Central Daylight Time	07/29/2015 04:41:09 PM Central Daylight Time			08/03/2015 08:19:47 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	058	0	2016	South Central Texas		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	059	0	1	04	01	H5521_059_0	4		1	08/01/2015	2016.01	08/01/2015 08:01:25 AM Central Daylight Time	08/02/2015 06:38:36 PM Central Daylight Time	07/29/2015 04:41:28 PM Central Daylight Time			08/03/2015 08:19:47 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	059	0	2016	North Central Texas		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	060	0	1	04	01	H5521_060_0	5		1	08/01/2015	2016.01	08/01/2015 08:01:42 AM Central Daylight Time	08/02/2015 06:39:14 PM Central Daylight Time	07/29/2015 04:41:47 PM Central Daylight Time			08/03/2015 08:19:47 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	060	0	2016	Southeast Texas		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	076	0	1	04	01	H5521_076_0	4		1	07/31/2015	2016.01	07/31/2015 10:53:31 PM Eastern Daylight Time	08/02/2015 02:48:28 PM Eastern Daylight Time	07/29/2015 05:42:06 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	076	0	2016	Rochester Area		2	9822	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	077	0	1	04	01	H5521_077_0	4		1	07/31/2015	2016.01	07/31/2015 10:55:54 PM Eastern Daylight Time	08/01/2015 10:08:24 AM Eastern Daylight Time	07/29/2015 05:42:25 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	077	0	2016	Broome, Cayuga, Oswego and Tioga counties		2	3369	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	081	0	1	04	01	H5521_081_0	6		1	07/31/2015	2016.01	07/31/2015 10:00:24 PM Eastern Daylight Time	07/31/2015 04:53:34 PM Eastern Daylight Time	07/29/2015 05:42:44 PM Eastern Daylight Time			08/01/2015 05:05:37 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	081	0	2016	North Carolina		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	082	0	1	04	01	H5521_082_0	5		1	07/31/2015	2016.01	07/31/2015 06:36:43 PM Eastern Daylight Time	07/31/2015 07:00:10 PM Eastern Daylight Time	07/29/2015 05:43:03 PM Eastern Daylight Time			07/31/2015 09:21:48 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	082	0	2016	Richmond and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	083	0	1	04	01	H5521_083_0	5		1	05/28/2015	2016.01	05/28/2015 12:57:53 PM Eastern Daylight Time	07/30/2015 02:56:15 PM Eastern Daylight Time	07/29/2015 05:43:22 PM Eastern Daylight Time			07/31/2015 09:21:48 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	083	0	2016	Danville City and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	084	0	1	04	01	H5521_084_0	7		1	07/31/2015	2016.01	07/31/2015 06:37:25 PM Eastern Daylight Time	07/31/2015 06:06:35 PM Eastern Daylight Time	07/29/2015 05:43:42 PM Eastern Daylight Time			07/31/2015 09:21:48 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	084	0	2016	Newport News and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	085	0	1	04	01	H5521_085_0	4		1	07/31/2015	2016.01	07/31/2015 11:05:53 PM Eastern Daylight Time	08/02/2015 09:03:59 PM Eastern Daylight Time	07/29/2015 05:44:01 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	085	0	2016	Boone, Campbell and Kenton counties		2	580	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	086	0	1	04	01	H5521_086_0	7		1	07/31/2015	2016.01	07/31/2015 10:00:57 PM Eastern Daylight Time	08/05/2015 01:15:58 PM Eastern Daylight Time	07/29/2015 05:44:20 PM Eastern Daylight Time			08/05/2015 01:49:11 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	086	0	2016	Cook county		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	087	0	1	04	01	H5521_087_0	4		1	07/31/2015	2016.01	07/31/2015 11:06:31 PM Eastern Daylight Time	08/02/2015 09:04:51 PM Eastern Daylight Time	07/29/2015 05:44:39 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	087	0	2016	Cincinnati and Surrounding area		2	5493	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	088	0	1	04	01	H5521_088_0	4		1	07/31/2015	2016.01	07/31/2015 11:06:54 PM Eastern Daylight Time	08/02/2015 09:06:55 PM Eastern Daylight Time	07/29/2015 05:44:58 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	088	0	2016	Toledo and Surrounding area		2	2061	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	089	0	1	04	01	H5521_089_0	4		1	07/31/2015	2016.01	07/31/2015 11:07:19 PM Eastern Daylight Time	08/02/2015 09:08:02 PM Eastern Daylight Time	07/29/2015 05:45:17 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	089	0	2016	Columbus and Surrounding Area		2	6300	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	090	0	1	04	01	H5521_090_0	4		1	07/31/2015	2016.01	07/31/2015 11:08:31 PM Eastern Daylight Time	08/02/2015 09:08:56 PM Eastern Daylight Time	07/29/2015 05:45:36 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	090	0	2016	Clark and Miami counties		2	996	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	091	0	1	04	01	H5521_091_0	8		1	07/31/2015	2016.01	07/31/2015 11:11:50 AM Eastern Daylight Time	07/31/2015 10:44:52 AM Eastern Daylight Time	07/29/2015 05:45:56 PM Eastern Daylight Time			08/01/2015 05:48:36 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	091	0	2016	Georgia and Alabama Counties		2	200	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	092	0	1	04	01	H5521_092_0	6		1	08/01/2015	2016.01	08/01/2015 09:21:47 AM Central Daylight Time	08/04/2015 08:50:12 AM Central Daylight Time	07/29/2015 04:46:15 PM Central Daylight Time			08/04/2015 02:45:00 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	092	0	2016	South Central Texas		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	093	0	1	04	01	H5521_093_0	7		1	08/01/2015	2016.01	08/01/2015 10:53:59 AM Central Daylight Time	08/04/2015 09:06:54 AM Central Daylight Time	07/29/2015 04:46:34 PM Central Daylight Time			08/04/2015 02:45:00 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	093	0	2016	North Central Texas		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	094	0	1	04	01	H5521_094_0	6		1	08/01/2015	2016.01	08/01/2015 09:22:15 AM Central Daylight Time	08/04/2015 08:57:52 AM Central Daylight Time	07/29/2015 04:46:53 PM Central Daylight Time			08/04/2015 02:45:00 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	094	0	2016	Southeast Texas		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	095	0	1	04	01	H5521_095_0	4		1	07/30/2015	2016.01	07/30/2015 05:12:48 PM Eastern Daylight Time	08/02/2015 10:55:43 AM Eastern Daylight Time	07/29/2015 05:47:13 PM Eastern Daylight Time			08/03/2015 10:51:23 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	095	0	2016	New Castle and Sussex counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	098	0	1	04	01	H5521_098_0	4		1	07/31/2015	2016.01	07/31/2015 10:57:01 PM Eastern Daylight Time	08/01/2015 10:11:12 AM Eastern Daylight Time	07/29/2015 05:47:32 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Syracuse Prime Plan (PPO)	01	04		1			H5521	098	0	2016	Onondaga county		2	1434	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	099	0	1	04	01	H5521_099_0	5		1	07/31/2015	2016.01	07/31/2015 10:01:25 PM Eastern Daylight Time	07/31/2015 07:31:01 PM Eastern Daylight Time	07/29/2015 05:47:51 PM Eastern Daylight Time			08/01/2015 11:48:44 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	099	0	2016	Fort Wayne		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	100	0	1	04	01	H5521_100_0	6		1	07/15/2015	2016.01	07/15/2015 09:20:54 AM Pacific Daylight Time	08/04/2015 10:53:44 AM Eastern Daylight Time	07/29/2015 05:48:10 PM Eastern Daylight Time			08/04/2015 03:54:50 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (PPO)	01	04		1			H5521	100	0	2016	Maricopa County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	101	0	1	04	01	H5521_101_0	5		1	07/16/2015	2016.01	07/16/2015 12:38:16 PM Pacific Daylight Time	08/02/2015 07:16:52 PM Eastern Daylight Time	07/29/2015 05:48:29 PM Eastern Daylight Time			08/03/2015 09:28:59 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	101	0	2016	Northern Utah		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	102	0	1	04	01	H5521_102_0	4		1	07/31/2015	2016.01	07/31/2015 06:37:51 PM Eastern Daylight Time	07/31/2015 05:29:23 PM Eastern Daylight Time	07/29/2015 05:48:49 PM Eastern Daylight Time			07/31/2015 09:21:48 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	102	0	2016	Roanoke and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	103	0	1	04	01	H5521_103_0	7		1	08/01/2015	2016.01	08/01/2015 08:59:36 AM Central Daylight Time	08/02/2015 06:52:08 PM Central Daylight Time	07/29/2015 04:49:08 PM Central Daylight Time			08/03/2015 08:25:06 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	103	0	2016	Austin and surrounding counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	104	0	1	04	01	H5521_104_0	8		1	08/05/2015	2016.01	08/05/2015 03:25:46 PM Central Daylight Time	08/02/2015 06:52:45 PM Central Daylight Time	07/29/2015 04:49:27 PM Central Daylight Time			08/05/2015 03:28:36 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare TX Connect Plus 1 (PPO)	01	04		1			H5521	104	0	2016	South Texas Metro Counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	105	0	1	04	01	H5521_105_0	8		1	08/01/2015	2016.01	08/01/2015 09:12:10 AM Central Daylight Time	08/02/2015 06:59:47 PM Central Daylight Time	07/29/2015 04:49:46 PM Central Daylight Time			08/03/2015 09:02:32 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	105	0	2016	Corpus Christi and surrounding counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	106	0	1	04	01	H5521_106_0	8		1	08/01/2015	2016.01	08/01/2015 10:26:08 AM Central Daylight Time	08/04/2015 10:11:36 AM Central Daylight Time	07/29/2015 04:50:05 PM Central Daylight Time			08/04/2015 02:26:33 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare TX Connect Plus 2 (PPO)	01	04		1			H5521	106	0	2016	South Texas Non Metro counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	107	0	1	04	01	H5521_107_0	5		1	08/01/2015	2016.01	08/01/2015 09:21:44 AM Central Daylight Time	08/02/2015 07:04:42 PM Central Daylight Time	07/29/2015 04:50:24 PM Central Daylight Time			08/03/2015 09:38:07 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	107	0	2016	El Paso County		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	108	0	1	04	01	H5521_108_0	9		1	08/01/2015	2016.01	08/01/2015 10:31:24 AM Central Daylight Time	08/04/2015 12:01:34 PM Central Daylight Time	07/29/2015 04:50:43 PM Central Daylight Time			08/04/2015 02:31:47 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare TX Connect Plus 2 (PPO)	01	04		1			H5521	108	0	2016	North Texas Non Metro counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	109	0	1	04	01	H5521_109_0	5		1	08/01/2015	2016.01	08/01/2015 09:18:11 AM Central Daylight Time	08/02/2015 07:07:12 PM Central Daylight Time	07/29/2015 04:51:02 PM Central Daylight Time			08/03/2015 10:09:00 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare TX Connect Plus 1 (PPO)	01	04		1			H5521	109	0	2016	North Texas Metro counties		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	110	0	1	04	01	H5521_110_0	6		1	07/16/2015	2016.01	07/16/2015 06:50:44 PM Eastern Daylight Time	08/01/2015 01:32:52 PM Eastern Daylight Time	07/29/2015 05:51:22 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	110	0	2016	Orange and Sullivan counties		2	403	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	111	0	1	04	01	H5521_111_0	5		1	07/16/2015	2016.01	07/16/2015 06:50:48 PM Eastern Daylight Time	08/01/2015 01:39:52 PM Eastern Daylight Time	07/29/2015 05:51:41 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	111	0	2016	Nassau county		2	353	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	112	0	1	04	01	H5521_112_0	4		1	07/31/2015	2016.01	07/31/2015 10:59:23 PM Eastern Daylight Time	08/01/2015 01:44:46 PM Eastern Daylight Time	07/29/2015 05:52:00 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	112	0	2016	Albany Metro area		2	705	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	113	0	1	04	01	H5521_113_0	4		1	07/07/2015	2016.01	07/07/2015 01:15:54 PM Eastern Daylight Time	08/01/2015 01:49:14 PM Eastern Daylight Time	07/29/2015 05:52:19 PM Eastern Daylight Time			08/03/2015 01:33:33 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	113	0	2016	Kings county		2	353	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	801	0	1	04	01	H5521_801_0	6		1	05/30/2015	2016.01	05/30/2015 08:00:01 PM Central Daylight Time	07/16/2015 03:47:08 PM Central Daylight Time				07/16/2015 04:45:38 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H5521	801	0	2016	National		1	343900	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1						2			
H5521	802	0	1	04	01	H5521_802_0	5		1	05/30/2015	2016.01	05/30/2015 08:47:31 PM Central Daylight Time	07/16/2015 03:50:10 PM Central Daylight Time				07/16/2015 04:45:38 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (PPO)	01	04		1			H5521	802	0	2016	National		1	116978	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1						2			
H5521	805	0	2	04	01	H5521_805_0	5		1	05/30/2015	2016.01	05/30/2015 09:02:53 PM Central Daylight Time	07/16/2015 03:53:03 PM Central Daylight Time				07/16/2015 04:45:38 PM Central 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	2016	National		1	10972	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1						2			
H5521	806	0	2	04	01	H5521_806_0	3		1	05/30/2015	2016.01	05/30/2015 09:10:50 PM Central Daylight Time	06/01/2015 09:49:34 AM Central Daylight Time				06/01/2015 10:45:37 AM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only Plan w/Rx CY (PPO)	01	04		2	1		H5521	806	0	2016	National		1	45	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1						2			
H5522	001	0	1	04	01	H5522_001_0	7		1	07/13/2015	2016.01	07/13/2015 09:05:52 PM Eastern Daylight Time	08/02/2015 10:52:15 AM Eastern Daylight Time	07/29/2015 05:52:38 PM Eastern Daylight Time			08/03/2015 11:32:54 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	001	0	2016	Allegheny County		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)291-5221		(866)291-5221		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	002	0	1	04	01	H5522_002_0	6		1	06/01/2015	2016.01	06/01/2015 12:20:37 PM Eastern Daylight Time	08/02/2015 10:51:28 AM Eastern Daylight Time	07/29/2015 05:52:57 PM Eastern Daylight Time			08/03/2015 11:32:54 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	002	0	2016	Central Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)291-5221		(866)291-5221		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	004	0	1	04	01	H5522_004_0	3		1	07/31/2015	2016.01	07/31/2015 08:32:27 PM Eastern Daylight Time	08/02/2015 10:50:41 AM Eastern Daylight Time	07/29/2015 05:53:16 PM Eastern Daylight Time			08/03/2015 10:35:28 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (PPO)	01	04		1			H5522	004	0	2016	Central Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)291-5221		(866)291-5221		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	005	0	1	04	01	H5522_005_0	3		1	07/31/2015	2016.01	07/31/2015 09:01:20 PM Eastern Daylight Time	08/02/2015 10:49:40 AM Eastern Daylight Time	07/29/2015 05:53:35 PM Eastern Daylight Time			08/03/2015 10:35:28 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (PPO)	01	04		1			H5522	005	0	2016	Western Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)291-5221		(866)291-5221		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	013	0	1	04	01	H5522_013_0	5		1	07/15/2015	2016.01	07/15/2015 01:21:03 PM Eastern Daylight Time	08/03/2015 02:18:48 PM Eastern Daylight Time	07/29/2015 05:53:54 PM Eastern Daylight Time			08/03/2015 02:23:25 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver Plus (PPO)	01	04		1			H5522	013	0	2016	Central Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)291-5221		(866)291-5221		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	014	0	1	04	01	H5522_014_0	6		1	06/01/2015	2016.01	06/01/2015 12:22:29 PM Eastern Daylight Time	08/02/2015 10:47:41 AM Eastern Daylight Time	07/29/2015 05:54:14 PM Eastern Daylight Time			08/03/2015 11:32:54 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	014	0	2016	Philadelphia and Delaware Counties		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)291-5221		(866)291-5221		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	015	0	1	04	01	H5522_015_0	8		1	07/14/2015	2016.01	07/14/2015 11:41:53 AM Eastern Daylight Time	08/02/2015 11:59:08 AM Eastern Daylight Time	07/29/2015 05:54:33 PM Eastern Daylight Time			08/03/2015 10:35:28 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	015	0	2016	Bucks, Chester and Montgomery		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)291-5221		(866)291-5221		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	017	0	1	04	01	H5522_017_0	3		1	06/01/2015	2016.01	06/01/2015 12:23:14 PM Eastern Daylight Time	08/02/2015 10:46:32 AM Eastern Daylight Time	07/29/2015 05:54:52 PM Eastern Daylight Time			08/03/2015 10:35:28 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	AdvantraOne (PPO)	01	04		1			H5522	017	0	2016	Central and Western PA		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	018	0	1	04	01	H5522_018_0	3		1	07/20/2015	2016.01	07/20/2015 04:49:29 PM Eastern Daylight Time	08/02/2015 12:06:34 AM Eastern Daylight Time	07/29/2015 05:55:11 PM Eastern Daylight Time			08/03/2015 10:35:28 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	ADVANTRA SILVER (PPO)	01	04		1			H5522	018	0	2016	Allegheny		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)338-9566		(855)338-9566		(866)290-6660		(866)290-6660		(855)338-9566		(855)338-9566		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	802	0	1	04	01	H5522_802_0	3		1	05/28/2015	2016.01	05/28/2015 09:42:43 AM Eastern Daylight Time	07/20/2015 11:07:27 AM Eastern Daylight Time				07/20/2015 11:09:01 AM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	Advantra MA Only (PPO)	01	04		1			H5522	802	0	2016	Pennsylvania		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H5522	803	0	1	04	01	H5522_803_0	2		1	05/27/2015	2016.01	05/27/2015 10:44:18 AM Eastern Daylight Time	07/16/2015 05:27:12 PM Eastern Daylight Time				07/16/2015 06:05:17 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	803	0	2016	Pennsylvania		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272		(866)291-5221		(866)291-5221		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H5525	004	0	1	04	01	H5525_004_0	3		1	07/08/2015	2016.01	07/08/2015 03:09:37 PM Eastern Daylight Time	08/04/2015 12:09:49 PM Eastern Daylight Time	07/29/2015 11:20:14 PM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-004 (PPO)	01	04		1			H5525	004	0	2016	Peoria Illinois area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 08:48:18 AM Eastern Daylight Time	07/31/2015 06:06:41 PM Eastern Daylight Time	07/29/2015 11:20:48 PM Eastern Daylight Time			08/04/2015 01:46:58 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-005 (PPO)	01	04		1			H5525	005	0	2016	Greater Philadelphia Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 08:48:31 AM Eastern Daylight Time	07/31/2015 05:59:52 PM Eastern Daylight Time	07/29/2015 11:21:24 PM Eastern Daylight Time			08/04/2015 01:46:58 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-006 (PPO)	01	04		1			H5525	006	0	2016	South Central Pennsylvania area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	007	0	1	04	01	H5525_007_0	3		1	07/08/2015	2016.01	07/08/2015 08:48:44 AM Eastern Daylight Time	07/31/2015 05:58:11 PM Eastern Daylight Time	07/29/2015 11:22:00 PM Eastern Daylight Time			08/04/2015 01:46:58 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-007 (PPO)	01	04		1			H5525	007	0	2016	North Central Pennsylvania area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	008	0	1	04	01	H5525_008_0	3		1	07/08/2015	2016.01	07/08/2015 07:58:14 AM Eastern Daylight Time	07/31/2015 05:59:22 PM Eastern Daylight Time	07/29/2015 11:22:34 PM Eastern Daylight Time			08/04/2015 02:14:30 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-008 (PPO)	01	04		1			H5525	008	0	2016	Select Counties in Indiana		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	009	0	1	04	01	H5525_009_0	3		1	07/08/2015	2016.01	07/08/2015 08:35:07 AM Eastern Daylight Time	07/31/2015 05:58:40 PM Eastern Daylight Time	07/29/2015 11:23:10 PM Eastern Daylight Time			08/04/2015 02:14:30 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-009 (PPO)	01	04		1			H5525	009	0	2016	Select counties in Indiana		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	015	0	1	04	01	H5525_015_0	3		1	07/08/2015	2016.01	07/08/2015 08:27:25 AM Eastern Daylight Time	08/03/2015 02:38:31 PM Eastern Daylight Time	07/29/2015 11:23:46 PM Eastern Daylight Time			08/04/2015 12:49:53 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-015 (PPO)	01	04		1			H5525	015	0	2016	Select Louisiana Parishes		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 08:48:58 AM Eastern Daylight Time	07/31/2015 06:13:09 PM Eastern Daylight Time	07/29/2015 11:24:20 PM Eastern Daylight Time			08/04/2015 01:46:58 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-017 (PPO)	01	04		1			H5525	017	0	2016	Pittsburgh Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	020	0	1	04	01	H5525_020_0	3		1	07/08/2015	2016.01	07/08/2015 10:32:27 AM Eastern Daylight Time	08/01/2015 10:02:19 AM Eastern Daylight Time	07/29/2015 11:24:56 PM Eastern Daylight Time			08/04/2015 01:06:43 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-020 (PPO)	01	04		1			H5525	020	0	2016	Mobile Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	021	0	1	04	01	H5525_021_0	3		1	07/09/2015	2016.01	07/09/2015 03:43:20 PM Eastern Daylight Time	07/31/2015 05:18:59 PM Eastern Daylight Time	07/29/2015 11:25:32 PM Eastern Daylight Time			08/04/2015 02:14:30 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-021 (PPO)	01	04		1			H5525	021	0	2016	Select counties in Eastern Kentucky		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	022	0	1	04	01	H5525_022_0	3		1	07/09/2015	2016.01	07/09/2015 03:48:05 PM Eastern Daylight Time	07/31/2015 05:19:19 PM Eastern Daylight Time	07/29/2015 11:26:08 PM Eastern Daylight Time			08/04/2015 02:14:30 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-022 (PPO)	01	04		1			H5525	022	0	2016	Select counties in Kentucky		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	023	0	1	04	01	H5525_023_0	3		1	07/08/2015	2016.01	07/08/2015 08:16:55 AM Eastern Daylight Time	07/31/2015 05:18:39 PM Eastern Daylight Time	07/29/2015 11:26:42 PM Eastern Daylight Time			08/04/2015 02:20:15 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-023 (PPO)	01	04		1			H5525	023	0	2016	Select counties in West Virginia		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	024	0	1	04	01	H5525_024_0	3		1	07/08/2015	2016.01	07/08/2015 08:17:00 AM Eastern Daylight Time	07/31/2015 04:03:45 PM Eastern Daylight Time	07/29/2015 11:27:18 PM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-024 (PPO)	01	04		1			H5525	024	0	2016	Select counties in Georgia		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	025	0	1	04	01	H5525_025_0	3		1	07/09/2015	2016.01	07/09/2015 03:37:30 PM Eastern Daylight Time	07/31/2015 04:04:37 PM Eastern Daylight Time	07/29/2015 11:27:54 PM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-025 (PPO)	01	04		1			H5525	025	0	2016	Select counties in South Carolina		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 08:17:46 AM Eastern Daylight Time	07/31/2015 04:31:32 PM Eastern Daylight Time	07/29/2015 11:28:30 PM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-026 (PPO)	01	04		1			H5525	026	0	2016	Select counties in North Carolina		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/07/2015	2016.01	07/07/2015 03:21:26 PM Eastern Daylight Time	08/04/2015 11:40:12 AM Eastern Daylight Time	07/29/2015 11:29:04 PM Eastern Daylight Time			08/04/2015 01:11:35 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-027 (PPO)	01	04		1			H5525	027	0	2016	Select counties in Montana		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 04:11:37 PM Eastern Daylight Time	08/01/2015 06:58:41 PM Eastern Daylight Time	07/29/2015 11:29:40 PM Eastern Daylight Time			08/04/2015 02:55:24 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-030 (PPO)	01	04		1			H5525	030	0	2016	Select Counites in Ohio and Kentucky		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	809	0	1	04	01	H5525_809_0	1		1	05/12/2015	2016.01	05/13/2015 11:39:27 AM Eastern Daylight Time	05/29/2015 11:11:03 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5525	809	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5525	810	0	1	04	01	H5525_810_0	1		1	05/13/2015	2016.01	05/13/2015 12:33:59 PM Eastern Daylight Time	05/29/2015 11:11:31 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5525	810	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5525	811	0	1	04	01	H5525_811_0	1		1	05/12/2015	2016.01	05/13/2015 11:40:41 AM Eastern Daylight Time	05/29/2015 11:11:58 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H5525	811	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5525	812	0	2	04	01	H5525_812_0	1		1	05/14/2015	2016.01	05/14/2015 08:21:39 AM Eastern Daylight Time	05/29/2015 11:12:25 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5525	812	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5525	813	0	2	04	01	H5525_813_0	1		1	05/14/2015	2016.01	05/14/2015 08:13:40 AM Eastern Daylight Time	05/29/2015 11:12:53 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5525	813	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5525	814	0	2	04	01	H5525_814_0	1		1	05/14/2015	2016.01	05/14/2015 08:22:07 AM Eastern Daylight Time	05/29/2015 11:13:22 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H5525	814	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5526	004	0	1	04	01	H5526_004_0	4		1	07/10/2015	2016.01	07/10/2015 12:45:02 PM Eastern Daylight Time	08/03/2015 04:56:46 PM Eastern Daylight Time	08/03/2015 02:33:58 PM Eastern Daylight Time			08/05/2015 03:11:40 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	BlueCross BlueShield Forever Blue Medicare PPO 751 (PPO)	01	04		1			H5526	004	0	2016	Western New York		2	2681	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	014	0	1	04	01	H5526_014_0	4		1	07/10/2015	2016.01	07/10/2015 12:45:22 PM Eastern Daylight Time	08/03/2015 04:58:14 PM Eastern Daylight Time	08/03/2015 02:32:58 PM Eastern Daylight Time			08/05/2015 03:11:40 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bsneny.com/medicare	BlueShield Forever Blue Medicare PPO 750 (PPO)	01	04		1			H5526	014	0	2016	Northeastern New York		2	685	2			2							www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	016	0	1	04	01	H5526_016_0	4		1	07/10/2015	2016.01	07/10/2015 12:45:36 PM Eastern Daylight Time	08/03/2015 04:24:38 PM Eastern Daylight Time	08/03/2015 02:32:04 PM Eastern Daylight Time			08/05/2015 03:11:40 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	Forever Blue Medicare PPO Value (PPO)	01	04		1			H5526	016	0	2016	Western New York		2	2570	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	017	0	1	04	01	H5526_017_0	5		1	07/10/2015	2016.01	07/10/2015 12:48:34 PM Eastern Daylight Time	08/03/2015 04:40:20 PM Eastern Daylight Time	08/03/2015 02:36:16 PM Eastern Daylight Time			08/05/2015 03:11:40 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bsneny.com/medicare	Forever Blue Medicare PPO Value (PPO)	01	04		1			H5526	017	0	2016	Northeastern New York		2	2484	2			2							www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5526	806	0	1	04	01	H5526_806_0	1		1	05/28/2015	2016.01	05/28/2015 03:07:36 PM Eastern Daylight Time	05/29/2015 05:34:55 PM Eastern Daylight Time				05/29/2015 05:58:57 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.nymedicare.com	PPO Group (MA Only) CY (PPO)	01	04		1			H5526	806	0	2016	Western and Northeastern New York		1	680	2			2							www.nymedicare.com	http://www.bcbswny.com/pharmacy	www.bcbswny.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;7c;7e;7h;7i;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;15;16b;	2		1						2			
H5526	808	0	1	04	01	H5526_808_0	1		1	05/28/2015	2016.01	05/28/2015 03:07:45 PM Eastern Daylight Time	05/29/2015 05:34:55 PM Eastern Daylight Time				05/29/2015 05:58:57 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.nymedicare.com	PPO Group (MA-PD) CY (PPO)	01	04		1			H5526	808	0	2016	Western and Northeastern New York		1	8755	2			2							www.nymedicare.com	http://www.bcbswny.com/pharmacy	www.bcbswny.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;3-1;3-2;3-3;5;7c;7e;7h;7i;8b1;8b2;9a;9b;9c;10a;11a;11b;11c;15;16b;	2		1						2			
H5528	001	0	1	04	01	H5528_001_0	4		1	05/27/2015	2016.01	05/27/2015 04:38:39 PM Eastern Daylight Time	07/08/2015 09:20:15 AM Eastern Daylight Time				07/08/2015 09:30:48 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth PPO I (PPO)	01	04		1			H5528	001	0	2016	Counties of New York City		2		2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5528	004	0	1	04	01	H5528_004_0	4		1	05/27/2015	2016.01	05/27/2015 04:38:50 PM Eastern Daylight Time	07/08/2015 09:20:40 AM Eastern Daylight Time				07/08/2015 09:30:48 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth PPO I (PPO)	01	04		1			H5528	004	0	2016	Nassau & Westchester Counties		2		2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5528	009	0	1	04	01	H5528_009_0	4		1	05/27/2015	2016.01	05/27/2015 04:39:00 PM Eastern Daylight Time	07/08/2015 09:20:51 AM Eastern Daylight Time				07/08/2015 09:30:48 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth PPO I (PPO)	01	04		1			H5528	009	0	2016	Suffolk County		2		2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5528	018	0	1	04	01	H5528_018_0	5	2	1	08/04/2015	2016.01	08/04/2015 03:13:22 PM Eastern Daylight Time	08/04/2015 04:43:33 PM Eastern Daylight Time	08/04/2015 04:43:50 PM Eastern Daylight Time			08/04/2015 04:47:19 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Dual Eligible (PPO SNP)	01	04		1			H5528	018	0	2016	NYC, Nassau, Suffolk, Westchester		2		2			1	3		1	4				www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5528	022	0	1	04	01	H5528_022_0	6		1	05/27/2015	2016.01	05/27/2015 04:39:27 PM Eastern Daylight Time	08/04/2015 04:50:56 PM Eastern Daylight Time	08/04/2015 04:51:08 PM Eastern Daylight Time			08/05/2015 08:50:21 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	022	0	2016	Bronx County		2		2			2								www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5528	023	0	1	04	01	H5528_023_0	5		1	05/27/2015	2016.01	05/27/2015 04:39:41 PM Eastern Daylight Time	08/04/2015 04:51:23 PM Eastern Daylight Time	08/04/2015 04:51:36 PM Eastern Daylight Time			08/05/2015 08:50:21 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	023	0	2016	New York and Kings County		2		2			2								www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5528	024	0	1	04	01	H5528_024_0	5		1	05/27/2015	2016.01	05/27/2015 04:39:51 PM Eastern Daylight Time	08/04/2015 04:51:58 PM Eastern Daylight Time	08/04/2015 04:52:08 PM Eastern Daylight Time			08/05/2015 08:50:21 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	024	0	2016	Richmond County		2		2			2								www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5528	025	0	1	04	01	H5528_025_0	6		1	05/29/2015	2016.01	05/29/2015 01:54:16 PM Eastern Daylight Time	08/04/2015 04:52:26 PM Eastern Daylight Time	08/10/2015 09:11:30 AM Eastern Daylight Time			08/10/2015 09:17:51 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	025	0	2016	Queens and Nassau County		2		2			2								www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5528	026	0	1	04	01	H5528_026_0	5		1	05/27/2015	2016.01	05/27/2015 04:40:16 PM Eastern Daylight Time	08/04/2015 04:52:57 PM Eastern Daylight Time	08/04/2015 04:53:06 PM Eastern Daylight Time			08/05/2015 08:50:21 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	026	0	2016	Suffolk and Westchester Counties		2		2			2								www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5528	807	0	1	04	01	H5528_807_0	3		1	05/27/2015	2016.01	05/27/2015 04:40:30 PM Eastern Daylight Time	07/08/2015 09:22:57 AM Eastern Daylight Time				07/08/2015 10:00:27 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Group Access Rx (PPO)	01	04		1			H5528	807	0	2016	United States		1		2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5530	006	1	1	04	01	H5530_006_1	10		1	07/20/2015	2016.01	07/20/2015 09:50:58 AM Eastern Daylight Time	08/01/2015 09:36:48 PM Eastern Daylight Time	07/30/2015 06:18:08 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H5530	006	1	2016	Select Counties in Kentucky	Select Counties in Kentucky	2	621	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7795		(855)690-7795		(800)797-1759		(800)797-1759		(855)690-7795		(855)690-7795		(844)364-2121		(844)364-2121		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5530	006	2	1	04	01	H5530_006_2	10		1	07/20/2015	2016.01	07/20/2015 09:52:40 AM Eastern Daylight Time	08/01/2015 09:37:22 PM Eastern Daylight Time	07/30/2015 06:18:44 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H5530	006	2	2016	Select Counties in Kentucky	Select Counties in Kentucky	2	3310	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7795		(855)690-7795		(800)797-1759		(800)797-1759		(855)690-7795		(855)690-7795		(844)364-2121		(844)364-2121		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5530	804	0	1	04	01	H5530_804_0	4		1	05/29/2015	2016.01	05/29/2015 12:28:14 PM Pacific Daylight Time	05/31/2015 09:38:58 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H5530	804	0	2016	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H5530	805	0	1	04	01	H5530_805_0	4		1	05/29/2015	2016.01	05/29/2015 12:29:58 PM Pacific Daylight Time	05/31/2015 01:17:12 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H5530	805	0	2016	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H5530	806	0	1	04	01	H5530_806_0	4		1	05/29/2015	2016.01	05/29/2015 12:30:24 PM Pacific Daylight Time	05/31/2015 01:17:17 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H5530	806	0	2016	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H5530	808	0	2	04	01	H5530_808_0	4		1	05/29/2015	2016.01	05/29/2015 12:30:52 PM Pacific Daylight Time	05/31/2015 01:17:22 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H5530	808	0	2016	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H5533	003	0	1	04	01	H5533_003_0	9		1	06/01/2015	2016.01	06/01/2015 01:11:52 PM Eastern Daylight Time	08/05/2015 01:42:29 PM Eastern Daylight Time	07/29/2015 04:34:22 PM Eastern Daylight Time			08/05/2015 04:19:38 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO High Deductible with Rx (PPO)	01	04		1			H5533	003	0	2016	Western Pennsylvania		2	12500	2			2							www.upmchealthplan.com/medicare/	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2						2			
H5533	005	0	1	04	01	H5533_005_0	9		1	07/07/2015	2016.01	07/07/2015 09:55:19 AM Eastern Daylight Time	08/05/2015 01:43:08 PM Eastern Daylight Time	07/29/2015 04:34:46 PM Eastern Daylight Time			08/05/2015 04:19:38 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	01	04		1			H5533	005	0	2016	Western PA		2	500	2			2							www.upmchealthplan.com/medicare/	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2						2			
H5533	006	0	1	04	01	H5533_006_0	9		1	06/01/2015	2016.01	06/01/2015 01:13:30 PM Eastern Daylight Time	08/05/2015 01:43:45 PM Eastern Daylight Time	07/29/2015 04:35:10 PM Eastern Daylight Time			08/05/2015 04:19:38 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO High Deductible with Rx (PPO)	01	04		1			H5533	006	0	2016	Lancaster County		2	12500	2			2							www.upmchealthplan.com/medicare/	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2						2			
H5533	801	0	1	04	01	H5533_801_0	3		1	05/19/2015	2016.01	05/19/2015 01:45:21 PM Eastern Daylight Time	05/30/2015 01:51:31 PM Eastern Daylight Time				05/30/2015 04:57:02 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PPO)	01	04		1			H5533	801	0	2016	Western Pennsylvania		1		2			2							www.upmchealthplan.com/medicare/	https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										1	1	1a;1b;2;5;6;8b1;9a;9b;11a;15;	2		1						2			
H5533	802	0	1	04	01	H5533_802_0	3		1	05/19/2015	2016.01	05/19/2015 01:48:37 PM Eastern Daylight Time	05/30/2015 01:52:17 PM Eastern Daylight Time				05/30/2015 04:57:02 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	01	04		1			H5533	802	0	2016	Western Pennsylvania		1		2			2							www.upmchealthplan.com/medicare/	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	1a;1b;2;5;6;8b1;9a;9b;11a;15;	2		1						2			
H5533	803	0	1	04	01	H5533_803_0	4		1	05/19/2015	2016.01	05/19/2015 01:53:18 PM Eastern Daylight Time	07/13/2015 12:44:38 PM Eastern Daylight Time				07/13/2015 12:45:55 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	01	04		1			H5533	803	0	2016	Western Pennsylvania		1		2			2							www.upmchealthplan.com/medicare/	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		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	1a;1b;2;5;6;8b1;9a;9b;11a;15;	2		1						2			
H5549	002	0	1	01	01	H5549_002_0	8	2	1	08/05/2015	2016.01	08/05/2015 11:19:36 AM Eastern Daylight Time	08/05/2015 01:14:14 PM Eastern Daylight Time	08/04/2015 05:39:18 PM Eastern Daylight Time			08/05/2015 03:33:10 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Medicare Preferred (HMO SNP)	01	01		1			H5549	002	0	2016	New York Metro Area		2	14454	2			1	3		1	2			www.vnsnychoice.org	http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5549	003	0	1	01	01	H5549_003_0	8	2	1	08/05/2015	2016.01	08/05/2015 11:28:35 AM Eastern Daylight Time	08/04/2015 05:41:02 PM Eastern Daylight Time	08/04/2015 05:46:23 PM Eastern Daylight Time			08/05/2015 03:33:10 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Total (HMO SNP)	01	01		1			H5549	003	0	2016	New York Metro Area		2	2374	2			1	3		1	5			www.vnsnychoice.org	http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5549	004	0	1	01	01	H5549_004_0	8		1	08/05/2015	2016.01	08/05/2015 11:36:24 AM Eastern Daylight Time	08/04/2015 04:55:45 PM Eastern Daylight Time	08/04/2015 04:57:13 PM Eastern Daylight Time			08/05/2015 03:33:10 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Medicare Enhanced (HMO)	01	01		1			H5549	004	0	2016	New York Metro Area		2	3468	2			2							www.vnsnychoice.org	http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5549	006	0	1	01	01	H5549_006_0	8	2	1	08/05/2015	2016.01	08/05/2015 11:32:14 AM Eastern Daylight Time	08/04/2015 06:02:07 PM Eastern Daylight Time	08/04/2015 06:04:35 PM Eastern Daylight Time			08/05/2015 03:33:10 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Medicare Maximum (HMO SNP)	01	01		1			H5549	006	0	2016	New York Metro Area		2	719	2			1	3		1	5			www.vnsnychoice.org	http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5549	008	0	1	01	01	H5549_008_0	9		1	08/05/2015	2016.01	08/05/2015 02:47:08 PM Eastern Daylight Time	08/04/2015 05:07:54 PM Eastern Daylight Time	08/12/2015 04:26:31 PM Eastern Daylight Time			08/13/2015 11:12:46 AM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Medicare Classic (HMO)	01	01		1			H5549	008	0	2016	New York Metro Area		2	3397	2			2							www.vnsnychoice.org	http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5549	009	0	1	02	01	H5549_009_0	10		1	08/05/2015	2016.01	08/05/2015 03:23:00 PM Eastern Daylight Time	08/04/2015 05:20:50 PM Eastern Daylight Time	08/04/2015 05:21:36 PM Eastern Daylight Time			08/05/2015 03:33:10 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Medicare Ultra (HMO-POS)	01	02		1			H5549	009	0	2016	New York Metro Area		2	650	2			2							www.vnsnychoice.org	http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5576	008	0	1	01	01	H5576_008_0	8		1	07/31/2015	2016.01	07/31/2015 10:27:57 AM Central Daylight Time	08/05/2015 01:31:47 PM Central Daylight Time	07/30/2015 06:41:00 PM Central Daylight Time			08/05/2015 02:13:31 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA4 Vantage TRADITIONAL PLUS (HMO)	01	01		1			H5576	008	0	2016	State of Louisiana		2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	012	0	1	02	01	H5576_012_0	9		1	07/31/2015	2016.01	07/31/2015 12:28:04 PM Central Daylight Time	08/05/2015 01:31:47 PM Central Daylight Time	07/30/2015 06:39:38 PM Central Daylight Time			08/05/2015 02:13:31 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA6 Vantage CAPITOL (HMO-POS)	01	02		1			H5576	012	0	2016	Southeast Louisiana		2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	016	1	1	02	01	H5576_016_1	9		1	08/05/2015	2016.01	08/05/2015 09:52:08 AM Central Daylight Time	08/05/2015 01:31:47 PM Central Daylight Time	07/30/2015 06:52:26 PM Central Daylight Time			08/05/2015 02:13:31 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA3 Vantage PREMIUM (HMO-POS)	01	02		1			H5576	016	1	2016	North Louisiana, Central Louisiana	Ouachita, DeSoto, East and West Carroll	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	1	01	7a;7g;8a1;8b1;8b3;9a;14e;	
H5576	016	2	1	02	01	H5576_016_2	9		1	08/05/2015	2016.01	08/05/2015 09:53:06 AM Central Daylight Time	08/05/2015 01:31:47 PM Central Daylight Time	07/30/2015 06:53:38 PM Central Daylight Time			08/05/2015 02:13:31 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA3 Vantage PREMIUM (HMO-POS)	01	02		1			H5576	016	2	2016	North Louisiana, Central Louisiana	North Louisiana, Central Louisiana	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	017	1	1	02	01	H5576_017_1	10		1	07/31/2015	2016.01	07/31/2015 01:36:27 PM Central Daylight Time	08/05/2015 01:31:47 PM Central Daylight Time	07/30/2015 06:55:38 PM Central Daylight Time			08/05/2015 02:13:31 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA0 Vantage ZERO (HMO-POS)	01	02		1			H5576	017	1	2016	North LA, SW LA, LaFourche, Terrebonne	Ouachita, DeSoto, East and West Carroll	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	1	01	7a;7g;8a1;8b1;8b3;9a;14e;	
H5576	017	2	1	02	01	H5576_017_2	10		1	07/31/2015	2016.01	07/31/2015 01:41:04 PM Central Daylight Time	08/05/2015 01:31:47 PM Central Daylight Time	07/30/2015 06:57:00 PM Central Daylight Time			08/05/2015 02:13:31 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA0 Vantage ZERO (HMO-POS)	01	02		1			H5576	017	2	2016	North LA, SW LA, LaFourche, Terrebonne	North LA, SW LA, LaFourche, Terrebonne	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	018	1	1	02	01	H5576_018_1	9		1	08/05/2015	2016.01	08/05/2015 09:53:38 AM Central Daylight Time	08/05/2015 01:31:47 PM Central Daylight Time	07/30/2015 06:58:11 PM Central Daylight Time			08/05/2015 02:13:31 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA1 Vantage VALUE (HMO-POS)	01	02		1			H5576	018	1	2016	North LA, SW LA, LaFourche, Terrebonne	Ouachita, DeSoto, East and West Carroll	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	1	01	7a;7g;8a1;8b1;8b3;9a;14e;	
H5576	018	2	1	02	01	H5576_018_2	9		1	08/05/2015	2016.01	08/05/2015 09:54:02 AM Central Daylight Time	08/05/2015 01:31:47 PM Central Daylight Time	07/30/2015 06:59:22 PM Central Daylight Time			08/05/2015 02:13:31 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA1 Vantage VALUE (HMO-POS)	01	02		1			H5576	018	2	2016	North LA, SW LA, LaFourche, Terrebonne	North LA, SW LA, LaFourche, Terrebonne	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	019	0	1	01	01	H5576_019_0	7	2	1	07/31/2015	2016.01	07/31/2015 01:51:24 PM Central Daylight Time	08/05/2015 01:31:46 PM Central Daylight Time	07/30/2015 05:21:29 PM Central Daylight Time			08/05/2015 02:13:31 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA7 Vantage Dual Special Needs Plan (HMO SNP)	01	01		1			H5576	019	0	2016	State of Louisiana		2		2			1	3		1	2			www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	801	0	1	02	01	H5576_801_0	4		1	07/13/2015	2016.01	07/13/2015 04:25:59 PM Central Daylight Time	05/29/2015 04:44:44 PM Central Daylight Time				07/13/2015 04:48:49 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	Vantage - MAPD Employer Calendar (HMO-POS)	01	02		1			H5576	801	0	2016	Louisiana		1		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	802	0	1	02	01	H5576_802_0	4		1	07/13/2015	2016.01	07/13/2015 04:29:35 PM Central Daylight Time	07/17/2015 08:15:12 AM Central Daylight Time				07/17/2015 08:19:57 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	Vantage - MAPD Emp Non-Calendar (HMO-POS)	01	02		1			H5576	802	0	2016	Louisiana		1		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2	2			
H5576	803	0	1	02	01	H5576_803_0	6		1	07/13/2015	2016.01	07/13/2015 04:29:40 PM Central Daylight Time	07/17/2015 08:15:12 AM Central Daylight Time				07/17/2015 08:19:57 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	Vantage - MA Employer Calendar (HMO-POS)	01	02		1			H5576	803	0	2016	Louisiana		1		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1									(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131										2					2					2	2			
H5577	002	0	1	01	01	H5577_002_0	6	1	1	07/09/2015	2016.01	07/09/2015 06:39:25 PM SA Western Standard Time	08/04/2015 04:44:09 PM SA Western Standard Time	08/04/2015 05:08:22 PM SA Western Standard Time			08/04/2015 05:49:23 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Ideal (HMO SNP)	01	01		1			H5577	002	0	2016	Puerto Rico		2	23772	2		1	1	3		1	3		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	8		1	07/18/2015	2016.01	07/18/2015 03:18:57 PM SA Western Standard Time	08/04/2015 04:45:57 PM SA Western Standard Time	08/04/2015 05:10:08 PM SA Western Standard Time			08/04/2015 05:49:23 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare InteliCare (HMO)	01	01		1			H5577	005	0	2016	Puerto Rico		2	12955	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	10		1	08/03/2015	2016.01	08/03/2015 12:40:57 PM SA Western Standard Time	08/04/2015 04:47:42 PM SA Western Standard Time	08/04/2015 05:13:42 PM SA Western Standard Time			08/04/2015 05:49:23 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Essential (HMO-POS)	01	02		1			H5577	008	0	2016	Puerto Rico		2	54950	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	009	0	1	01	01	H5577_009_0	7	1	1	07/10/2015	2016.01	07/10/2015 02:23:26 PM SA Western Standard Time	08/04/2015 04:55:04 PM SA Western Standard Time	08/04/2015 05:14:36 PM SA Western Standard Time			08/04/2015 05:49:23 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Mximo (HMO SNP)	01	01		1			H5577	009	0	2016	Puerto Rico		2	11457	2		1	1	3		1	3		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	010	0	1	01	01	H5577_010_0	8	1	1	07/10/2015	2016.01	07/10/2015 02:23:42 PM SA Western Standard Time	08/04/2015 04:56:32 PM SA Western Standard Time	08/04/2015 05:15:48 PM SA Western Standard Time			08/28/2015 02:13:39 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Superior (HMO SNP)	01	01		1			H5577	010	0	2016	Puerto Rico		2	28126	2		1	1	3		1	3		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	014	0	1	01	01	H5577_014_0	6		1	08/04/2015	2016.01	08/04/2015 04:40:44 PM SA Western Standard Time	08/04/2015 04:58:23 PM SA Western Standard Time	08/04/2015 05:16:36 PM SA Western Standard Time			08/04/2015 05:49:23 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MediCa$h (HMO)	01	01		1			H5577	014	0	2016	Puerto Rico		2	65	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	015	0	1	02	01	H5577_015_0	7		1	07/15/2015	2016.01	07/15/2015 10:25:29 AM SA Western Standard Time	08/04/2015 05:00:54 PM SA Western Standard Time	08/04/2015 05:18:04 PM SA Western Standard Time			08/04/2015 05:49:23 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare PremiumPlus (HMO-POS)	01	02		1			H5577	015	0	2016	Puerto Rico		2	65	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	016	0	1	01	01	H5577_016_0	5		1	07/10/2015	2016.01	07/10/2015 02:54:39 PM SA Western Standard Time	06/01/2015 05:02:45 PM SA Western Standard Time				07/10/2015 03:28:01 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MediOnlyNoRx (HMO)	01	01		1			H5577	016	0	2016	Puerto Rico		2	65	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	6	1	1	08/03/2015	2016.01	08/03/2015 09:19:45 AM SA Western Standard Time	08/04/2015 05:03:13 PM SA Western Standard Time	08/04/2015 05:19:52 PM SA Western Standard Time			08/04/2015 05:49:23 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Progreso (HMO SNP)	01	01		1			H5577	017	0	2016	Puerto Rico		2	4235	2		1	1	3		1	3		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	018	0	1	01	01	H5577_018_0	6	1	1	08/03/2015	2016.01	08/03/2015 09:21:59 AM SA Western Standard Time	08/04/2015 05:05:24 PM SA Western Standard Time	08/04/2015 05:20:55 PM SA Western Standard Time			08/04/2015 05:49:23 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Crdito (HMO SNP)	01	01		1			H5577	018	0	2016	Puerto Rico		2	20887	2		1	1	3		1	3		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	019	0	1	01	01	H5577_019_0	6	1	1	08/03/2015	2016.01	08/03/2015 09:22:51 AM SA Western Standard Time	08/04/2015 05:07:08 PM SA Western Standard Time	08/04/2015 05:21:57 PM SA Western Standard Time			08/04/2015 05:49:23 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Mayor (HMO SNP)	01	01		1			H5577	019	0	2016	Puerto Rico		2	927	2		1	1	3		1	3		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2	2			
H5577	801	0	1	01	01	H5577_801_0	2		1	06/01/2015	2016.01	06/01/2015 04:24:44 PM SA Western Standard Time	06/01/2015 05:05:17 PM SA Western Standard Time				06/01/2015 05:42:19 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA Group (HMO)	01	01		1			H5577	801	0	2016	Puerto Rico		1	65	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					1	2			
H5577	802	0	1	01	01	H5577_802_0	2		1	06/01/2015	2016.01	06/01/2015 03:48:37 AM SA Western Standard Time	06/01/2015 05:06:01 PM SA Western Standard Time				06/01/2015 05:42:19 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	2016	Puerto Rico		1	15493	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					1	2			
H5577	803	0	1	01	01	H5577_803_0	2		1	06/01/2015	2016.01	06/01/2015 04:24:27 PM SA Western Standard Time	06/01/2015 05:06:55 PM SA Western Standard Time				06/01/2015 05:42:19 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 10 (HMO)	01	01		1			H5577	803	0	2016	Puerto Rico		1	65	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					1	2			
H5577	804	0	1	01	01	H5577_804_0	2		1	05/20/2015	2016.01	05/20/2015 06:54:49 PM SA Western Standard Time	06/01/2015 05:07:34 PM SA Western Standard Time				06/01/2015 05:42:19 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 20 (HMO)	01	01		1			H5577	804	0	2016	Puerto Rico		1	17895	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					1	2			
H5577	805	0	1	01	01	H5577_805_0	2		1	05/20/2015	2016.01	05/20/2015 06:56:15 PM SA Western Standard Time	06/01/2015 05:08:14 PM SA Western Standard Time				06/01/2015 05:42:19 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 30 (HMO)	01	01		1			H5577	805	0	2016	Puerto Rico		1	65	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					1	2			
H5577	806	0	1	01	01	H5577_806_0	2		1	05/20/2015	2016.01	05/20/2015 06:56:30 PM SA Western Standard Time	06/01/2015 05:08:49 PM SA Western Standard Time				06/01/2015 05:42:19 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 40 (HMO)	01	01		1			H5577	806	0	2016	Puerto Rico		1	65	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					1	2			
H5577	808	0	1	01	01	H5577_808_0	1		1	05/20/2015	2016.01	05/20/2015 06:56:48 PM SA Western Standard Time	06/01/2015 05:10:28 PM SA Western Standard Time				06/01/2015 05:42:19 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	808	0	2016	Puerto Rico		1	65	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					1	2			
H5577	809	0	1	01	01	H5577_809_0	2		1	05/20/2015	2016.01	05/20/2015 06:57:05 PM SA Western Standard Time	06/01/2015 05:11:08 PM SA Western Standard Time				06/01/2015 05:42:19 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 10 2nd Formulary Opt. (HMO)	01	01		1			H5577	809	0	2016	Puerto Rico		1	65	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					1	2			
H5577	810	0	1	01	01	H5577_810_0	2		1	05/20/2015	2016.01	05/20/2015 06:57:32 PM SA Western Standard Time	06/01/2015 05:11:45 PM SA Western Standard Time				06/01/2015 05:42:19 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 20 2nd Formulary Opt. (HMO)	01	01		1			H5577	810	0	2016	Puerto Rico		1	65	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					1	2			
H5577	811	0	1	01	01	H5577_811_0	2		1	05/20/2015	2016.01	05/20/2015 06:58:19 PM SA Western Standard Time	06/01/2015 05:12:21 PM SA Western Standard Time				06/01/2015 05:42:19 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 30 2nd Formulary Opt. (HMO)	01	01		1			H5577	811	0	2016	Puerto Rico		1	65	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					1	2			
H5577	812	0	1	01	01	H5577_812_0	2		1	05/20/2015	2016.01	05/20/2015 06:58:30 PM SA Western Standard Time	06/01/2015 05:13:23 PM SA Western Standard Time				06/01/2015 05:42:19 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 40 2nd Formulary Opt. (HMO)	01	01		1			H5577	812	0	2016	Puerto Rico		1	65	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					1	2			
H5580	001	0	1	01	01	H5580_001_0	4	2	1	08/04/2015	2016.01	08/04/2015 04:12:03 PM Pacific Daylight Time	08/04/2015 07:17:24 PM Pacific Daylight Time	08/04/2015 03:56:27 PM Pacific Daylight Time			08/05/2015 07:26:36 AM Pacific Daylight Time	SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO SNP)	01	01		1			H5580	001	0	2016	Maricopa and Pima Counties		2	11754	2			1	3		1	4			www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(800)624-3879		(602)263-3000		(866)571-5781		(602)414-7630		(800)624-3879		(602)263-3000		(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	3	2	1	08/04/2015	2016.01	08/04/2015 04:12:14 PM Pacific Daylight Time	08/04/2015 07:18:53 PM Pacific Daylight Time	08/04/2015 03:56:35 PM Pacific Daylight Time			08/05/2015 07:26:36 AM Pacific Daylight Time	SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO SNP)	01	01		1			H5580	004	0	2016	Maricopa and Pima Counties		2	5749	2			1	3		1	4			www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(800)624-3879		(602)263-3000		(866)571-5781		(602)414-7630		(800)624-3879		(602)263-3000		(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	3	2	1	08/04/2015	2016.01	08/04/2015 04:12:23 PM Pacific Daylight Time	08/04/2015 07:18:19 PM Pacific Daylight Time	08/04/2015 03:56:09 PM Pacific Daylight Time			08/05/2015 07:26:36 AM Pacific Daylight Time	SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO SNP)	01	01		1			H5580	005	0	2016	Maricopa, Pima and Santa Cruz Counties		2	1219	2			1	3		1	4			www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(800)624-3879		(602)263-3000		(866)571-5781		(602)414-7630		(800)624-3879		(602)263-3000		(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	7	2	1	08/05/2015	2016.01	08/05/2015 03:31:10 PM US Mountain Standard Time	08/05/2015 01:43:22 PM US Mountain Standard Time	08/05/2015 01:43:22 PM US Mountain Standard Time			08/05/2015 03:39:06 PM US Mountain Standard Time	HEALTH CHOICE ARIZONA, INC.	Health Choice Generations HMO SNP	www.healthchoicegenerations.com	Health Choice Generations (HMO SNP)	01	01		1			H5587	002	0	2016	Counties: APA,CCN, GIL, MAR, MOH, NAV, PIM, PIN		2		2			1	3		1	4			http://www.healthchoicearizona.com/Directory/search.asp?bl=hcg	http://www.hcgenerations.com/index.asp?page=formulary.asp&f=partd	http://www.hcgenerations.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	002	0	1	01	01	H5590_002_0	6	2	1	08/03/2015	2016.01	08/03/2015 01:47:48 PM Pacific Daylight Time	08/03/2015 09:55:28 AM Pacific Daylight Time	07/30/2015 12:10:30 PM Pacific Daylight Time			08/04/2015 03:25:50 PM Pacific Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Bridgeway Health Solutions	http://advantage.bridgewayhs.com	Bridgeway Health Solutions Advantage (HMO SNP)	01	01		1			H5590	002	0	2016	Five counties in Central and Southeast Arizona		2	1614	2			1	3		1	4			http://advantage.bridgewayhs.com/home/find-a-provider-or-pharmacy/	http://advantage.bridgewayhs.com/home/prescription-drug-part-d-benefit-information/formulary/	http://advantage.bridgewayhs.com/home/find-a-provider-or-pharmacy/	(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	001	0	1	02	01	H5591_001_0	8		1	07/30/2015	2016.01	07/30/2015 07:47:58 PM Eastern Daylight Time	08/04/2015 01:56:52 PM Eastern Daylight Time	08/04/2015 01:56:52 PM Eastern Daylight Time			08/04/2015 02:52:58 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	001	0	2016	Aroo,Fran,Han,Knx,Linc,Oxf,Pen,Som,Pisc,Wald,Wash		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	003	0	1	01	01	H5591_003_0	8		1	07/21/2015	2016.01	07/21/2015 04:14:17 PM Eastern Daylight Time	07/22/2015 10:46:33 AM Eastern Daylight Time				07/22/2015 11:16:26 AM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value (HMO)	01	01		1			H5591	003	0	2016	State of Maine		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5591	005	0	1	02	01	H5591_005_0	8		1	07/30/2015	2016.01	07/30/2015 07:51:38 PM Eastern Daylight Time	08/04/2015 01:56:53 PM Eastern Daylight Time	08/04/2015 01:56:53 PM Eastern Daylight Time			08/04/2015 02:52:58 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	005	0	2016	Hillsborough, Strafford, NH		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	006	1	1	02	01	H5591_006_1	8		1	07/30/2015	2016.01	07/30/2015 07:55:35 PM Eastern Daylight Time	08/04/2015 01:56:53 PM Eastern Daylight Time	08/04/2015 01:56:53 PM Eastern Daylight Time			08/04/2015 02:52:58 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	1	2016	Andr,Cumb,Kenn,Saga, York	Andr,Cumb	2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	006	2	1	02	01	H5591_006_2	8		1	07/30/2015	2016.01	07/30/2015 07:58:04 PM Eastern Daylight Time	08/04/2015 01:56:53 PM Eastern Daylight Time	08/04/2015 01:56:54 PM Eastern Daylight Time			08/04/2015 02:52:58 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	2	2016	Andr,Cumb,Kenn,Saga, York	Kenn,Saga, York	2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	007	0	1	01	01	H5591_007_0	10		1	07/30/2015	2016.01	07/30/2015 08:01:47 PM Eastern Daylight Time	08/04/2015 01:56:54 PM Eastern Daylight Time	08/04/2015 01:56:54 PM Eastern Daylight Time			08/04/2015 02:52:58 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Focus DC (HMO SNP)	01	01		1			H5591	007	0	2016	Cumberland		2		2			1	4		1		00000010000000000000		www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(888)423-9320		(888)423-9320		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	008	0	1	01	01	H5591_008_0	9		1	07/30/2015	2016.01	07/30/2015 08:03:40 PM Eastern Daylight Time	08/04/2015 01:56:54 PM Eastern Daylight Time	08/04/2015 01:56:55 PM Eastern Daylight Time			08/04/2015 02:52:58 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value Plus (HMO)	01	01		1			H5591	008	0	2016	York		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(771)-		(711)-		(711)-		(711)-		(771)-		(711)-		(711)-		2					2					2	2			
H5591	009	0	1	01	01	H5591_009_0	9		1	07/30/2015	2016.01	07/30/2015 08:06:39 PM Eastern Daylight Time	08/04/2015 01:56:55 PM Eastern Daylight Time	08/04/2015 01:56:55 PM Eastern Daylight Time			08/04/2015 02:52:58 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value Plus (HMO)	01	01		1			H5591	009	0	2016	Penobscot		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(771)-		(771)-		(711)-		(711)-		(771)-		(771)-		2					2					2	2			
H5591	801	0	1	02	01	H5591_801_0	5		1	05/31/2015	2016.01	05/31/2015 09:14:19 AM Eastern Daylight Time	07/17/2015 02:23:31 PM Eastern Daylight Time				07/20/2015 03:42:15 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime Group (HMO-POS)	01	02		1			H5591	801	0	2016	National		1		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	802	0	1	02	01	H5591_802_0	5		1	05/31/2015	2016.01	05/31/2015 09:14:32 AM Eastern Daylight Time	07/17/2015 02:23:22 PM Eastern Daylight Time				07/20/2015 03:42:15 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime Group (HMO-POS)	01	02		1			H5591	802	0	2016	National		1		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	001	0	1	01	01	H5594_001_0	7		1	08/05/2015	2016.01	08/05/2015 04:55:12 PM Eastern Daylight Time	08/05/2015 05:07:12 PM Eastern Daylight Time	08/04/2015 05:48:52 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	001	0	2016	Select Counties in Florida		2	0	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	002	0	1	01	01	H5594_002_0	8		1	08/05/2015	2016.01	08/05/2015 04:55:27 PM Eastern Daylight Time	08/04/2015 10:51:48 PM Eastern Daylight Time	08/04/2015 05:49:58 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO)	01	01		1			H5594	002	0	2016	Select Counties in Florida		2	0	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	016	0	1	01	01	H5594_016_0	7	2	1	08/05/2015	2016.01	08/05/2015 04:56:11 PM Eastern Daylight Time	08/04/2015 10:53:46 PM Eastern Daylight Time	08/04/2015 05:51:08 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Emerald Partial (HMO SNP)	01	01		1			H5594	016	0	2016	Select Counties in Florida		2	0	2			1	3		1	4			www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	017	0	1	01	01	H5594_017_0	7	2	1	08/05/2015	2016.01	08/05/2015 04:56:31 PM Eastern Daylight Time	08/04/2015 10:55:30 PM Eastern Daylight Time	08/04/2015 05:52:38 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Emerald Full (HMO SNP)	01	01		1			H5594	017	0	2016	Select Counties in Florida		2	0	2			1	3		1	5			www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	019	0	1	01	01	H5594_019_0	8		1	08/05/2015	2016.01	08/05/2015 04:56:56 PM Eastern Daylight Time	08/05/2015 05:09:24 PM Eastern Daylight Time	08/04/2015 05:53:38 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO)	01	01		1			H5594	019	0	2016	Select Counties in Florida		2	0	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	022	0	1	01	01	H5594_022_0	8		1	08/05/2015	2016.01	08/05/2015 04:57:11 PM Eastern Daylight Time	08/04/2015 10:56:52 PM Eastern Daylight Time	08/04/2015 05:55:32 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	022	0	2016	Select Counties in Florida		2	0	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	026	0	1	01	01	H5594_026_0	8		1	08/05/2015	2016.01	08/05/2015 04:57:27 PM Eastern Daylight Time	08/04/2015 10:58:46 PM Eastern Daylight Time	08/04/2015 06:28:40 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	01	01		1			H5594	026	0	2016	Select Counties in Florida		2	0	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	028	0	1	01	01	H5594_028_0	8		1	08/05/2015	2016.01	08/05/2015 04:57:40 PM Eastern Daylight Time	08/04/2015 11:01:16 PM Eastern Daylight Time	08/05/2015 11:16:36 AM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO SNP)	01	01		1			H5594	028	0	2016	Select Counties in Florida		2	0	2			1	4		1		00000000000000000010		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	029	0	1	01	01	H5594_029_0	8		1	08/05/2015	2016.01	08/05/2015 04:57:55 PM Eastern Daylight Time	08/04/2015 11:03:18 PM Eastern Daylight Time	08/04/2015 06:30:58 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO SNP)	01	01		1			H5594	029	0	2016	Select Counties in Florida		2	0	2			1	4		1		00000000000100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	030	0	1	01	01	H5594_030_0	8		1	08/05/2015	2016.01	08/05/2015 04:58:05 PM Eastern Daylight Time	08/04/2015 11:04:50 PM Eastern Daylight Time	08/04/2015 06:32:16 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO SNP)	01	01		1			H5594	030	0	2016	Select Counties in Florida		2	0	2			1	4		1		00000000000000000010		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	031	0	1	01	01	H5594_031_0	8		1	08/05/2015	2016.01	08/05/2015 04:58:15 PM Eastern Daylight Time	08/04/2015 11:06:36 PM Eastern Daylight Time	08/04/2015 06:33:04 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO SNP)	01	01		1			H5594	031	0	2016	Select Counties in Florida		2	0	2			1	4		1		00000000000100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	032	0	1	01	01	H5594_032_0	8		1	08/05/2015	2016.01	08/05/2015 04:58:31 PM Eastern Daylight Time	08/05/2015 05:10:34 PM Eastern Daylight Time	08/04/2015 06:34:04 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Plus Plan (HMO)	01	01		1			H5594	032	0	2016	Select Counties in Florida		2	0	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	034	0	1	01	01	H5594_034_0	7		1	08/05/2015	2016.01	08/05/2015 04:58:45 PM Eastern Daylight Time	08/05/2015 05:12:08 PM Eastern Daylight Time	08/04/2015 06:35:06 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO SNP)	01	01		1			H5594	034	0	2016	select counties in FL		2	0	2			1	4		1		00000000000000000010		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	035	0	1	01	01	H5594_035_0	7		1	08/05/2015	2016.01	08/05/2015 04:58:56 PM Eastern Daylight Time	08/05/2015 05:13:14 PM Eastern Daylight Time	08/04/2015 06:36:54 PM Eastern Daylight Time			08/05/2015 07:09:35 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO SNP)	01	01		1			H5594	035	0	2016	select counties in FL		2	0	2			1	4		1		00000000000100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5608	001	0	1	01	01	H5608_001_0	5	2	1	07/08/2015	2016.01	07/08/2015 08:00:01 AM Mountain Daylight Time	07/31/2015 01:48:10 PM Mountain Daylight Time	07/31/2015 02:50:18 PM Mountain Daylight Time			08/05/2015 09:10:25 AM Mountain Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Denver Health Medical Plan, Inc.	http://www.denverhealthmedicalplan.org	Denver Health Medicare Choice (HMO SNP)	01	01		1			H5608	001	0	2016	Denver County		2	1430	2			1	3		1	4			https://www.viiad.com/dhmp/provider_main.asp	http://www.denverhealthmedicalplan.org	http://www.denverhealthmedicalplan.org	(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		2					2					2	2			
H5608	002	0	1	01	01	H5608_002_0	8		1	07/08/2015	2016.01	07/08/2015 08:03:45 AM Mountain Daylight Time	07/31/2015 01:50:42 PM Mountain Daylight Time	07/31/2015 02:57:46 PM Mountain Daylight Time			08/05/2015 09:10:25 AM Mountain Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Denver Health Medical Plan, Inc.	http://www.denverhealthmedicalplan.org	Denver Health Medicare Select (HMO)	01	01		1			H5608	002	0	2016	Denver County		2	2435	2			2							https://www.viiad.com/dhmp/provider_main.asp	http://www.denverhealthmedicalplan.org	http://www.denverhealthmedicalplan.org	(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		2					2					2	2			
H5609	001	0	1	01	01	H5609_001_0	8		1	08/04/2015	2016.01	08/04/2015 04:34:47 PM Pacific Daylight Time	08/10/2015 05:50:14 PM Pacific Daylight Time	08/05/2015 10:37:54 AM Pacific Daylight Time			08/10/2015 05:54:14 PM Pacific Daylight Time	GEMCARE HEALTH PLAN INC.	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H5609	001	0	2016	Kern County (partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	7a;	
H5609	004	0	1	01	01	H5609_004_0	8		1	08/04/2015	2016.01	08/04/2015 04:35:26 PM Pacific Daylight Time	08/10/2015 05:50:12 PM Pacific Daylight Time	08/05/2015 10:37:44 AM Pacific Daylight Time			08/10/2015 06:03:27 PM Pacific Daylight Time	GEMCARE HEALTH PLAN INC.	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H5609	004	0	2016	San Luis Obispo/Santa Barbara Counties (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5609	801	0	1	01	01	H5609_801_0	1		1	05/27/2015	2016.01	05/27/2015 12:57:56 PM Pacific Daylight Time	06/01/2015 02:53:33 PM Pacific Daylight Time				06/01/2015 03:27:55 PM Pacific Daylight Time	GEMCARE HEALTH PLAN INC.	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H5609	801	0	2016	Employer Group Plan		1		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	2					2	2			
H5610	001	0	1	20	08	H5610_001_0	2		1	05/21/2015	2016.01	05/21/2015 10:14:59 AM Eastern Daylight Time		05/20/2015 06:41:33 PM Eastern Daylight Time			05/21/2015 10:16:04 AM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.care-resources.org	Care Resources (PACE)	08	20		1			H5610	001	0	2016	Kent County		2		2			2								www.care-resources.org	www.care-resources.org									(800)610-6299		(616)913-2006		(800)610-6299		(616)913-2006										(800)649-3777		(616)913-2006		(800)649-3777		(616)913-2006																
H5610	003	0	1	20	08	H5610_003_0	3		1	05/21/2015	2016.01	05/21/2015 10:21:57 AM Eastern Daylight Time		05/20/2015 06:41:34 PM Eastern Daylight Time			05/21/2015 10:22:08 AM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.care-resources.org	Care Resources (PACE)	08	20		1			H5610	003	0	2016	Kent County		2		2			2								www.care-resources.org	www.care-resources.org									(800)610-6299		(616)913-2006		(800)610-6299		(616)913-2006										(800)649-3777		(616)913-2006		(800)649-3777		(616)913-2006																
H5613	001	0	1	07	02	H5613_001_0	8		2	07/15/2015	2016.01	07/15/2015 05:09:30 PM Eastern Daylight Time			05/31/2015 07:48:45 PM Eastern Daylight Time		07/15/2015 05:28:13 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	Medi-CareFund	mvphealthcare.com	SmartFund (MSA)	02	07	2	1			H5613	001	0	2016	Western NY		2	150	2			2										(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5613	002	0	1	07	02	H5613_002_0	6		2	07/15/2015	2016.01	07/15/2015 05:09:44 PM Eastern Daylight Time			05/31/2015 07:48:51 PM Eastern Daylight Time		07/15/2015 05:28:13 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	Medi-CareFund	mvphealthcare.com	SmartFund (MSA)	02	07	2	1			H5613	002	0	2016	Eastern NY		2	150	2			2										(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5613	801	0	1	07	02	H5613_801_0	4		2	06/26/2015	2016.01	06/26/2015 09:13:06 AM Eastern Daylight Time			05/31/2015 07:48:57 PM Eastern Daylight Time		07/15/2015 05:30:57 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	Medi-CareFund	mvphealthcare.com	SmartFund EG (MSA)	02	07	2	1			H5613	801	0	2016	Western NY		1	150	2			2										(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5613	802	0	1	07	02	H5613_802_0	4		2	06/26/2015	2016.01	06/26/2015 09:13:18 AM Eastern Daylight Time			05/31/2015 07:49:04 PM Eastern Daylight Time		07/15/2015 05:30:57 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	Medi-CareFund	mvphealthcare.com	SmartFund EG (MSA)	02	07	2	1			H5613	802	0	2016	Eastern NY		1	150	2			2										(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5619	001	0	1	01	01	H5619_001_0	3		1	07/08/2015	2016.01	07/08/2015 02:28:34 PM Eastern Daylight Time	08/03/2015 03:14:15 PM Eastern Daylight Time	07/30/2015 12:06:34 PM Eastern Daylight Time			08/04/2015 01:01:02 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-001 (HMO)	01	01		1			H5619	001	0	2016	Southern Maine Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	003	0	1	01	01	H5619_003_0	4	2	1	07/15/2015	2016.01	07/15/2015 09:46:35 AM Eastern Daylight Time	08/03/2015 01:46:26 PM Eastern Daylight Time	07/29/2015 11:30:50 PM Eastern Daylight Time			08/04/2015 01:01:02 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H5619-003 (HMO SNP)	01	01		1			H5619	003	0	2016	Select Counties in Maine		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	007	0	1	01	01	H5619_007_0	3		1	07/08/2015	2016.01	07/08/2015 02:30:09 PM Eastern Daylight Time	08/03/2015 11:37:19 AM Eastern Daylight Time	07/30/2015 12:07:10 PM Eastern Daylight Time			08/04/2015 01:01:02 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-007 (HMO)	01	01		1			H5619	007	0	2016	Select Counties in Maine and New Hampshire		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	011	0	1	01	01	H5619_011_0	3		1	07/08/2015	2016.01	07/08/2015 02:30:50 PM Eastern Daylight Time	08/03/2015 01:42:31 PM Eastern Daylight Time	07/29/2015 11:32:02 PM Eastern Daylight Time			08/04/2015 01:01:02 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-011 (HMO)	01	01		1			H5619	011	0	2016	Select Counties in Maine		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/09/2015	2016.01	07/09/2015 01:13:23 PM Eastern Daylight Time	08/03/2015 04:28:57 PM Eastern Daylight Time	07/29/2015 11:32:36 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-012 (HMO)	01	01		1			H5619	012	0	2016	Fresno County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/09/2015	2016.01	07/09/2015 01:13:55 PM Eastern Daylight Time	08/03/2015 05:17:50 PM Eastern Daylight Time	07/29/2015 11:33:12 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-013 (HMO)	01	01		1			H5619	013	0	2016	Madera County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	014	0	1	01	01	H5619_014_0	3		1	07/08/2015	2016.01	07/08/2015 01:54:34 PM Eastern Daylight Time	08/03/2015 04:31:12 PM Eastern Daylight Time	07/29/2015 11:33:48 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-014 (HMO)	01	01		1			H5619	014	0	2016	Fresno County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/09/2015	2016.01	07/09/2015 01:52:48 PM Eastern Daylight Time	08/03/2015 04:32:51 PM Eastern Daylight Time	07/30/2015 12:07:46 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-015 (HMO)	01	01		1			H5619	015	0	2016	Tulare and Kings counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	4		1	07/08/2015	2016.01	07/08/2015 02:12:34 PM Eastern Daylight Time	08/03/2015 04:43:25 PM Eastern Daylight Time	07/29/2015 11:34:58 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-016 (HMO)	01	01		1			H5619	016	0	2016	San Diego County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	017	0	1	01	01	H5619_017_0	3		1	07/07/2015	2016.01	07/07/2015 03:35:23 PM Eastern Daylight Time	08/03/2015 04:44:53 PM Eastern Daylight Time	07/29/2015 11:35:34 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-017 (HMO)	01	01		1			H5619	017	0	2016	San Diego County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	018	0	1	01	01	H5619_018_0	2		1	07/08/2015	2016.01	07/08/2015 11:30:29 AM Eastern Daylight Time	05/24/2015 02:36:31 PM Eastern Daylight Time				07/10/2015 03:06:12 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-018 (HMO)	01	01		1			H5619	018	0	2016	Select Counties in California		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5619	019	0	1	01	01	H5619_019_0	3		1	07/08/2015	2016.01	07/08/2015 11:41:36 AM Eastern Daylight Time	08/03/2015 04:50:00 PM Eastern Daylight Time	07/30/2015 12:08:22 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-019 (HMO)	01	01		1			H5619	019	0	2016	Riverside and San Bernardino counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	020	0	1	01	01	H5619_020_0	3		1	07/08/2015	2016.01	07/08/2015 01:56:21 PM Eastern Daylight Time	08/03/2015 04:51:55 PM Eastern Daylight Time	07/30/2015 12:08:58 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-020 (HMO)	01	01		1			H5619	020	0	2016	Riverside and San Bernardino counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 01:57:22 PM Eastern Daylight Time	08/03/2015 04:55:27 PM Eastern Daylight Time	07/30/2015 12:09:36 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-021 (HMO)	01	01		1			H5619	021	0	2016	Los Angeles and Orange counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	022	0	1	01	01	H5619_022_0	3		1	07/08/2015	2016.01	07/08/2015 01:58:08 PM Eastern Daylight Time	08/03/2015 04:57:42 PM Eastern Daylight Time	07/30/2015 12:10:12 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-022 (HMO)	01	01		1			H5619	022	0	2016	Los Angeles and Orange counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	023	0	1	01	01	H5619_023_0	3		1	07/08/2015	2016.01	07/08/2015 02:48:15 PM Eastern Daylight Time	08/03/2015 04:59:48 PM Eastern Daylight Time	07/29/2015 11:38:30 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-023 (HMO)	01	01		1			H5619	023	0	2016	Santa Barbara (partial) and Ventura counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	024	0	1	01	01	H5619_024_0	3		1	07/07/2015	2016.01	07/07/2015 03:36:09 PM Eastern Daylight Time	08/03/2015 04:41:08 PM Eastern Daylight Time	07/30/2015 12:10:48 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-024 (HMO)	01	01		1			H5619	024	0	2016	Select Counties in California		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	025	0	1	01	01	H5619_025_0	3		1	07/07/2015	2016.01	07/07/2015 03:36:27 PM Eastern Daylight Time	08/03/2015 04:41:47 PM Eastern Daylight Time	07/29/2015 11:39:42 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-025 (HMO)	01	01		1			H5619	025	0	2016	Santa Clara County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/07/2015	2016.01	07/07/2015 03:36:50 PM Eastern Daylight Time	08/03/2015 04:47:44 PM Eastern Daylight Time	07/30/2015 12:11:24 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-026 (HMO)	01	01		1			H5619	026	0	2016	San Joaquin County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/07/2015	2016.01	07/07/2015 03:37:29 PM Eastern Daylight Time	08/03/2015 04:54:08 PM Eastern Daylight Time	07/30/2015 12:12:00 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-029 (HMO)	01	01		1			H5619	029	0	2016	Contra Costa County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	030	0	1	01	01	H5619_030_0	4		1	07/08/2015	2016.01	07/08/2015 11:31:29 AM Eastern Daylight Time	08/03/2015 04:34:12 PM Eastern Daylight Time	07/29/2015 11:41:28 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-030 (HMO)	01	01		1			H5619	030	0	2016	Santa Cruz County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	031	0	1	01	01	H5619_031_0	4		1	07/09/2015	2016.01	07/09/2015 12:54:54 PM Eastern Daylight Time	08/03/2015 04:37:41 PM Eastern Daylight Time	07/29/2015 11:42:02 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-031 (HMO)	01	01		1			H5619	031	0	2016	Stanislaus County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 02:13:30 PM Eastern Daylight Time	08/03/2015 04:40:13 PM Eastern Daylight Time	07/30/2015 12:12:38 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-032 (HMO)	01	01		1			H5619	032	0	2016	Stanislaus County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	033	0	1	01	01	H5619_033_0	3		1	07/09/2015	2016.01	07/09/2015 01:14:30 PM Eastern Daylight Time	08/03/2015 05:14:42 PM Eastern Daylight Time	07/30/2015 12:13:14 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-033 (HMO)	01	01		1			H5619	033	0	2016	Sacramento County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	034	0	1	01	01	H5619_034_0	3		1	07/07/2015	2016.01	07/07/2015 03:37:54 PM Eastern Daylight Time	08/03/2015 05:12:35 PM Eastern Daylight Time	07/30/2015 12:13:50 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-034 (HMO)	01	01		1			H5619	034	0	2016	Sacramento County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	035	0	1	01	01	H5619_035_0	3		1	07/09/2015	2016.01	07/09/2015 01:15:07 PM Eastern Daylight Time	08/03/2015 05:07:02 PM Eastern Daylight Time	07/30/2015 12:14:26 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-035 (HMO)	01	01		1			H5619	035	0	2016	Placer County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	036	0	1	01	01	H5619_036_0	3		1	07/09/2015	2016.01	07/09/2015 01:15:38 PM Eastern Daylight Time	08/03/2015 05:16:24 PM Eastern Daylight Time	07/30/2015 12:15:02 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-036 (HMO)	01	01		1			H5619	036	0	2016	Yolo County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	037	0	1	01	01	H5619_037_0	3		1	07/08/2015	2016.01	07/08/2015 02:00:40 PM Eastern Daylight Time	08/03/2015 05:08:53 PM Eastern Daylight Time	07/30/2015 12:15:38 PM Eastern Daylight Time			08/04/2015 12:53:00 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-037 (HMO)	01	01		1			H5619	037	0	2016	Select Counties in California		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2	1	07/07/2015	2016.01	07/07/2015 03:38:17 PM Eastern Daylight Time	08/03/2015 05:05:23 PM Eastern Daylight Time	07/30/2015 12:16:14 PM Eastern Daylight Time			08/04/2015 12:54:21 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H5619-038 (HMO SNP)	01	01		1			H5619	038	0	2016	Select Counties in California		2		2			1	3		1	3		2	www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	2		1	05/11/2015	2016.01	05/11/2015 02:39:30 PM Eastern Daylight Time	07/15/2015 09:32:59 AM Eastern Daylight Time				07/21/2015 06:39:13 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H5619	802	0	2016	Select Counties in ME, CA and NH		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5619	803	0	1	01	01	H5619_803_0	1		1	05/11/2015	2016.01	05/11/2015 02:40:33 PM Eastern Daylight Time	05/29/2015 08:24:04 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H5619	803	0	2016	Select Counties in ME, CA and NH		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5628	001	0	1	01	01	H5628_001_0	7	2	1	08/05/2015	2016.01	08/05/2015 04:37:02 PM Pacific Daylight Time	08/04/2015 04:13:16 PM Pacific Daylight Time	07/30/2015 08:57:36 AM Pacific Daylight Time			08/05/2015 04:42:57 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5628	001	0	2016	Northern/ Central/ Southern Utah		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(888)665-1328		(888)665-1328		(866)403-8293		(866)403-8293		(888)665-1328		(888)665-1328		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5628	006	0	1	01	01	H5628_006_0	5	2	1	08/04/2015	2016.01	08/04/2015 04:28:33 PM Pacific Daylight Time	08/04/2015 01:38:04 PM Pacific Daylight Time	07/30/2015 08:57:48 AM Pacific Daylight Time			08/05/2015 12:13:04 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.uhealthplan.utah.edu/healthy_advantage.html	Healthy Advantage (HMO SNP)	01	01		1			H5628	006	0	2016	Northern/ Central Utah		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.uhealthplan.utah.edu/healthy_advantage.html	www.molinahealthcare.com/medicare	(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5628	007	0	1	01	01	H5628_007_0	8		1	08/04/2015	2016.01	08/04/2015 04:28:43 PM Pacific Daylight Time	08/05/2015 08:49:02 AM Pacific Daylight Time	07/30/2015 08:58:00 AM Pacific Daylight Time			08/05/2015 12:13:04 PM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.uhealthplan.utah.edu/healthy_advantage.html	Healthy Advantage Plus (HMO)	01	01		1			H5628	007	0	2016	Northern/Central Utah		2		2			2							www.molinahealthcare.com/medicare	www.uhealthplan.utah.edu/healthy_advantage.html	www.molinahealthcare.com/medicare	(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5629	001	0	1	20	08	H5629_001_0	1		1	05/21/2015	2016.01	05/21/2015 09:29:48 AM Pacific Daylight Time		05/21/2015 09:26:43 AM Pacific Daylight Time			05/21/2015 09:39:50 AM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE (PACE)	08	20		1			H5629	001	0	2016	San Diego Metro Area		2		2			2								stpaulspace.org	stpaulspace.org									(619)239-6900		(619)239-6900		(619)239-6900		(619)239-6900										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H5629	002	0	1	20	08	H5629_002_0	1		1	05/21/2015	2016.01	05/21/2015 09:30:14 AM Pacific Daylight Time		05/21/2015 09:26:45 AM Pacific Daylight Time			05/21/2015 09:39:50 AM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE (PACE)	08	20		1			H5629	002	0	2016	San Diego Metro Area		2		2			2								stpaulspace.org	stpaulspace.org									(619)239-6900		(619)239-6900		(619)239-6900		(619)239-6900										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H5649	001	0	1	01	01	H5649_001_0	8		1	08/03/2015	2016.01	08/03/2015 03:55:50 PM Eastern Daylight Time	08/03/2015 03:43:55 PM Eastern Daylight Time	08/03/2015 03:50:00 PM Eastern Daylight Time			08/05/2015 04:30:10 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Medicare Plan (HMO)	01	01		1			H5649	001	0	2016	Counties:  LA, partial OC, partial SB		2	18779	2			2							www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	002	0	1	01	01	H5649_002_0	10	2	1	09/22/2015	2016.01	09/22/2015 05:30:42 PM Eastern Daylight Time	08/06/2015 04:47:24 PM Eastern Daylight Time	08/03/2015 03:53:42 PM Eastern Daylight Time			09/23/2015 05:09:17 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Medi-Medi Plan (HMO SNP)	01	01		1			H5649	002	0	2016	Counties: LA, partial SB		2	5529	2			1	3		1	2			www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	004	0	1	01	01	H5649_004_0	8		1	08/03/2015	2016.01	08/03/2015 03:56:16 PM Eastern Daylight Time	08/03/2015 03:43:19 PM Eastern Daylight Time	08/03/2015 03:53:27 PM Eastern Daylight Time			08/05/2015 04:28:19 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Premier Plan (HMO)	01	01		1			H5649	004	0	2016	Counties:  LA, partial OC, partial SB		2	9247	2			2							www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	006	0	1	01	01	H5649_006_0	10		1	08/03/2015	2016.01	08/03/2015 03:56:34 PM Eastern Daylight Time	08/03/2015 03:44:13 PM Eastern Daylight Time	08/03/2015 03:53:08 PM Eastern Daylight Time			08/05/2015 04:30:10 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Focus Plan (HMO SNP)	01	01		1			H5649	006	0	2016	Los Angeles, Orange and San Bernardino		2	2475	2			1	4		1		00000000000000000010		www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	007	0	1	01	01	H5649_007_0	9		1	08/03/2015	2016.01	08/03/2015 03:56:49 PM Eastern Daylight Time	08/03/2015 03:42:30 PM Eastern Daylight Time	08/03/2015 03:52:50 PM Eastern Daylight Time			08/05/2015 04:30:10 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Advance Plan (HMO SNP)	01	01		1			H5649	007	0	2016	Los Angeles		2	58	2			1	1	3	1				www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	008	0	1	01	01	H5649_008_0	10		1	07/09/2015	2016.01	07/09/2015 12:02:40 PM Eastern Daylight Time	08/03/2015 03:48:00 PM Eastern Daylight Time	08/03/2015 03:52:36 PM Eastern Daylight Time			08/05/2015 04:30:10 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Ventura Medicare Plan (HMO)	01	01		1			H5649	008	0	2016	Partial Ventura County		2	480	2			2							www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	009	0	1	01	01	H5649_009_0	11	2	1	09/22/2015	2016.01	09/22/2015 05:03:13 PM Eastern Daylight Time	08/06/2015 04:47:45 PM Eastern Daylight Time	08/03/2015 03:52:22 PM Eastern Daylight Time			09/23/2015 05:09:17 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Ventura Medi-Medi Plan (HMO SNP)	01	01		1			H5649	009	0	2016	Partial Ventura County		2	5529	2			1	3		1	2			www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/Pharmacy.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5649	010	0	1	01	01	H5649_010_0	9		1	07/08/2015	2016.01	07/08/2015 08:54:11 AM Eastern Daylight Time	08/03/2015 03:48:29 PM Eastern Daylight Time	08/03/2015 03:53:52 PM Eastern Daylight Time			08/05/2015 04:30:10 PM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Ventura Premier Plan (HMO)	01	01		1			H5649	010	0	2016	Partial Ventura County		2	9247	2			2							www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/Pharmacy.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2	2			
H5652	001	0	1	02	01	H5652_001_0	5		1	09/16/2015	2016.01	09/16/2015 02:46:30 PM Central Daylight Time	09/15/2015 04:04:08 PM Central Daylight Time	09/15/2015 03:04:10 PM Central Daylight Time			09/16/2015 02:56:08 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Signature with Drugs (HMO-POS)	01	02		1			H5652	001	0	2016	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA		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	3		1	09/16/2015	2016.01	09/16/2015 02:46:34 PM Central Daylight Time	09/15/2015 01:33:05 PM Central Daylight Time				09/16/2015 02:56:08 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Signature without Drugs (HMO-POS)	01	02		1			H5652	002	0	2016	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA		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	5		1	07/16/2015	2016.01	07/16/2015 08:40:33 AM Central Daylight Time	07/31/2015 01:50:05 PM Central Daylight Time	07/30/2015 10:39:35 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Guardian (HMO-POS SNP)	01	02		1			H5652	003	0	2016	Erickson Campuses - CO, MA, MD, MI, NJ, PA, TX, VA		2		2			1	1	1	1				www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5652	004	0	1	02	01	H5652_004_0	3		1	05/29/2015	2016.01	05/29/2015 10:39:49 AM Central Daylight Time	07/31/2015 01:50:30 PM Central Daylight Time	07/30/2015 10:39:50 AM Central Daylight Time			08/03/2015 03:22:01 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Champion (HMO-POS SNP)	01	02		1			H5652	004	0	2016	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA		2		2			1	4		1		00011010000000000000		www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5652	006	0	1	02	01	H5652_006_0	5		1	09/16/2015	2016.01	09/16/2015 02:46:40 PM Central Daylight Time	09/15/2015 04:04:42 PM Central Daylight Time	09/15/2015 03:04:35 PM Central Daylight Time			09/16/2015 02:56:08 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Freedom (HMO-POS)	01	02		1			H5652	006	0	2016	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA		2		2			2							www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5656	001	0	1	01	01	H5656_001_0	7		1	07/14/2015	2016.01	07/14/2015 03:18:04 PM Central Daylight Time	08/03/2015 12:48:52 PM Central Daylight Time	07/31/2015 03:27:56 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American Corp.	www.TexanPlus.com	TexanPlus Classic (HMO)	01	01		1			H5656	001	0	2016	Dallas Metroplex Area		2		2			2							www.TexanPlus.com	www.TexanPlus.com	www.TexanPlus.com	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5656	801	0	1	01	01	H5656_801_0	5		1	05/30/2015	2016.01	05/30/2015 12:21:49 PM Central Daylight Time	06/24/2015 12:48:18 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American Corp.	www.Universal-American-Medicare.com	Retiree - MA-PD CY (HMO)	01	01		1			H5656	801	0	2016	Employer Group--North Texas (MAPD--CY)		1		2			2							www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5656	802	0	1	01	01	H5656_802_0	5		1	05/30/2015	2016.01	05/30/2015 12:22:28 PM Central Daylight Time	06/24/2015 12:56:30 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American Corp.	www.Universal-American-Medicare.com	Retiree - MA-PD non-CY (HMO)	01	01		1			H5656	802	0	2016	Employer Group--North Texas (MAPD--non-CY)		1		2			2							www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5656	803	0	1	01	01	H5656_803_0	5		1	05/30/2015	2016.01	05/30/2015 12:23:31 PM Central Daylight Time	06/24/2015 01:04:33 PM Central Daylight Time				07/13/2015 04:58:59 PM Central Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American Corp.	www.Universal-American-Medicare.com	Retiree - MA (HMO)	01	01		1			H5656	803	0	2016	Employer Group--North Texas (MA--CY)		1		2			2							www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5685	001	0	1	01	01	H5685_001_0	6	2	1	07/21/2015	2016.01	07/21/2015 05:07:57 PM Eastern Daylight Time	08/04/2015 03:32:52 PM Eastern Daylight Time	08/04/2015 03:32:51 PM Eastern Daylight Time			08/04/2015 03:36:11 PM Eastern Daylight Time	HAP MIDWEST HEALTH PLAN, INC.	HAP Midwest Advantage	www.hap.org/midwestadvantage	HAP Midwest Health Plan (HMO SNP)	01	01		1			H5685	001	0	2016	HAP Midwest Advantage of Southeast Michigan		2	701	2			1	3		1	3		1	www.hap.org/midwestadvantage	www.hap.org/midwestadvantage	www.hap.org/midwestadvantage	(888)654-0706		(313)581-3700		(888)654-0706		(313)581-3700		(888)445-5580		(313)581-3700		(888)654-0706		(313)581-3700		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5698	028	0	1	01	01	H5698_028_0	5		1	08/05/2015	2016.01	08/05/2015 09:33:31 AM Eastern Daylight Time	08/03/2015 01:59:57 PM Eastern Daylight Time	08/03/2015 04:02:46 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO)	01	01		1			H5698	028	0	2016	Select Counties in MS		2	8630	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	035	0	1	01	01	H5698_035_0	3		1	07/10/2015	2016.01	07/10/2015 01:01:05 PM Eastern Daylight Time	05/31/2015 12:45:34 PM Eastern Daylight Time				07/14/2015 03:41:10 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO)	01	01		1			H5698	035	0	2016	Select Counties in AR, MS, SC, and TN		2	1420	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056										(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272										2					2					2	2			
H5698	062	0	1	01	01	H5698_062_0	5		1	08/01/2015	2016.01	08/01/2015 09:25:49 AM Eastern Daylight Time	08/03/2015 02:01:37 PM Eastern Daylight Time	08/03/2015 04:03:13 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H5698	062	0	2016	Select Counties in TN		2	3049	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	063	0	1	01	01	H5698_063_0	5		1	08/01/2015	2016.01	08/01/2015 09:26:03 AM Eastern Daylight Time	08/03/2015 02:02:27 PM Eastern Daylight Time	08/03/2015 04:03:41 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H5698	063	0	2016	Select Counties in AR		2	6969	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	128	0	1	01	01	H5698_128_0	4	2	1	07/10/2015	2016.01	07/10/2015 01:01:50 PM Eastern Daylight Time	08/03/2015 02:03:17 PM Eastern Daylight Time	08/03/2015 04:04:08 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H5698	128	0	2016	Select Counties in AR		2	5176	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	134	0	1	01	01	H5698_134_0	4	2	1	07/10/2015	2016.01	07/10/2015 01:01:59 PM Eastern Daylight Time	08/03/2015 02:04:07 PM Eastern Daylight Time	08/03/2015 04:04:35 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H5698	134	0	2016	Select Counties in MS		2	7995	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	140	0	1	01	01	H5698_140_0	4	2	1	07/10/2015	2016.01	07/10/2015 01:02:19 PM Eastern Daylight Time	08/03/2015 02:04:57 PM Eastern Daylight Time	08/03/2015 04:05:02 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H5698	140	0	2016	Select Counties in TN		2	5608	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	158	0	1	01	01	H5698_158_0	4	2	1	07/10/2015	2016.01	07/10/2015 01:02:27 PM Eastern Daylight Time	08/03/2015 02:05:48 PM Eastern Daylight Time	08/03/2015 04:05:28 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H5698	158	0	2016	Select Counties in SC		2	946	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	159	0	1	01	01	H5698_159_0	4		1	08/01/2015	2016.01	08/01/2015 09:26:22 AM Eastern Daylight Time	08/03/2015 02:06:33 PM Eastern Daylight Time	08/03/2015 04:05:55 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	01	01		1			H5698	159	0	2016	Select Counties in SC		2	1812	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	198	0	1	02	01	H5698_198_0	3		1	08/01/2015	2016.01	08/01/2015 09:26:40 AM Eastern Daylight Time	08/03/2015 02:07:19 PM Eastern Daylight Time	08/03/2015 04:06:23 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H5698	198	0	2016	Hinds, Madison, Rankin, Warren Counties		2	593	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	199	0	1	02	01	H5698_199_0	4		1	08/01/2015	2016.01	08/01/2015 09:27:04 AM Eastern Daylight Time	08/03/2015 02:08:01 PM Eastern Daylight Time	08/03/2015 04:06:50 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO-POS)	01	02		1			H5698	199	0	2016	Select Counties in TN		2	1988	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	200	0	1	01	01	H5698_200_0	4	2	1	07/10/2015	2016.01	07/10/2015 01:03:18 PM Eastern Daylight Time	08/03/2015 02:08:54 PM Eastern Daylight Time	08/03/2015 04:07:16 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Access (HMO SNP)	01	01		1			H5698	200	0	2016	Select Counties in MS		2	981	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	203	0	1	01	01	H5698_203_0	5		1	07/10/2015	2016.01	07/10/2015 01:03:35 PM Eastern Daylight Time	08/03/2015 02:09:43 PM Eastern Daylight Time	08/03/2015 04:07:44 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H5698	203	0	2016	Select Counties in AR		2	341	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5698	204	0	1	01	01	H5698_204_0	5		1	07/10/2015	2016.01	07/10/2015 01:03:44 PM Eastern Daylight Time	08/03/2015 02:10:35 PM Eastern Daylight Time	08/03/2015 04:08:12 PM Eastern Daylight Time			08/05/2015 10:26:30 AM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	01	01		1			H5698	204	0	2016	Select Counties in TN		2	337	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)316-2273		(800)316-2273		(866)527-0056		(866)527-0056		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H5703	001	0	1	01	01	H5703_001_0	2	2	1	05/18/2015	2016.01	05/18/2015 12:41:56 PM Central Daylight Time	08/03/2015 05:03:23 PM Central Daylight Time	08/03/2015 05:00:40 PM Central Daylight Time			08/04/2015 10:53:51 AM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	AbilityCare (HMO SNP)	01	01		1			H5703	001	0	2016	Select Counties in Minnesota		2	581	1	1		1	3		1	5			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	10		1	08/01/2015	2016.01	08/01/2015 03:50:02 AM Pacific Daylight Time	08/01/2015 06:37:57 PM Pacific Daylight Time	07/30/2015 04:20:22 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Amerigroup Community Care of New Mexico	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H5746	016	0	2016	Bernalillo, Sandoval,Torrance, Valencia, Santa Fe		2	1808	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5774	003	0	1	01	01	H5774_003_0	6		1	07/27/2015	2016.01	07/27/2015 10:15:08 PM SA Western Standard Time	06/01/2015 08:56:46 AM SA Western Standard Time				07/27/2015 10:48:21 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Basic (HMO)	01	01		1			H5774	003	0	2016	Puerto Rico		2	277	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2					2	1	11	7d;7g;8a1;8a2;11a;11b1;11b2;17a;18a;	7b;7f;17a;18a1;18a2;
H5774	005	0	1	01	01	H5774_005_0	10		1	07/28/2015	2016.01	07/28/2015 11:43:09 PM SA Western Standard Time	08/05/2015 09:26:46 AM SA Western Standard Time	08/04/2015 10:16:34 AM SA Western Standard Time			08/05/2015 10:00:42 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal (HMO)	01	01		1			H5774	005	0	2016	Puerto Rico		2	27209	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(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;9b;11a;11b1;11b2;17a;18a;	17a;18a1;18a2;
H5774	008	0	1	01	01	H5774_008_0	9		1	07/27/2015	2016.01	07/27/2015 10:17:32 PM SA Western Standard Time	08/05/2015 09:26:56 AM SA Western Standard Time	08/04/2015 10:16:45 AM SA Western Standard Time			08/05/2015 10:00:42 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Classic (HMO)	01	01		1			H5774	008	0	2016	Puerto Rico		2	842	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(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;11a;11b1;11b2;17a;18a;	
H5774	022	0	1	01	01	H5774_022_0	8		1	07/27/2015	2016.01	07/27/2015 10:18:24 PM SA Western Standard Time	08/05/2015 09:27:10 AM SA Western Standard Time	08/04/2015 10:17:05 AM SA Western Standard Time			08/05/2015 10:00:42 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Vital Plus (HMO SNP)	01	01		1			H5774	022	0	2016	Puerto Rico		2	203	2			1	4		1		00000000000000000010		www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(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;8a1;8a2;11a;11b1;11b2;18a;	18a1;
H5774	023	0	1	01	01	H5774_023_0	8		1	07/27/2015	2016.01	07/27/2015 10:21:45 PM SA Western Standard Time	08/05/2015 09:27:18 AM SA Western Standard Time	08/04/2015 10:17:14 AM SA Western Standard Time			08/05/2015 10:00:42 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal Plus (HMO)	01	01		1			H5774	023	0	2016	Puerto Rico		2	27209	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(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;8a1;8a2;9b;11a;11b1;11b2;18a;	18a1;18a2;
H5774	024	0	1	01	01	H5774_024_0	11	1	1	07/27/2015	2016.01	07/27/2015 10:29:56 PM SA Western Standard Time	08/05/2015 09:27:27 AM SA Western Standard Time	08/04/2015 10:17:24 AM SA Western Standard Time			08/05/2015 10:00:42 AM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Platino Plus (HMO SNP)	01	01		1			H5774	024	0	2016	Puerto Rico		2	42833	2		1	1	3		1	3		1	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(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	11a;11b1;11b2;	
H5774	802	0	1	01	01	H5774_802_0	5		1	06/04/2015	2016.01	06/04/2015 07:14:43 PM SA Western Standard Time	07/17/2015 03:19:47 PM SA Western Standard Time				07/20/2015 08:07:17 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal A (HMO)	01	01		1			H5774	802	0	2016	Puerto Rico		1	99	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5774	806	0	1	01	01	H5774_806_0	4		1	06/04/2015	2016.01	06/04/2015 07:15:28 PM SA Western Standard Time	06/01/2015 08:56:14 AM SA Western Standard Time				06/05/2015 05:25:58 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal B (HMO)	01	01		1			H5774	806	0	2016	Puerto Rico		1	935	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(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	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5774	808	0	1	01	01	H5774_808_0	5		1	06/04/2015	2016.01	06/04/2015 07:16:58 PM SA Western Standard Time	07/17/2015 03:11:58 PM SA Western Standard Time				07/20/2015 08:07:17 PM SA Western Standard Time	TRIPLE S ADVANTAGE, INC.	Triple S Advantage	www.sssadvantage.com	Royal C (HMO)	01	01		1			H5774	808	0	2016	Puerto Rico		1	99	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(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	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H5774	809	0	1	02	01	H5774_809_0	2		1	06/04/2015	2016.01	06/04/2015 07:18:52 PM SA Western Standard Time	06/01/2015 08:56:20 AM SA Western Standard Time				06/05/2015 05:25:58 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	2016	Puerto Rico		1	99	2			2							www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(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	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1	2			
H5779	001	0	1	01	01	H5779_001_0	6	2	1	07/20/2015	2016.01	07/20/2015 10:54:52 AM Eastern Daylight Time	08/03/2015 12:17:14 PM Eastern Daylight Time	07/30/2015 04:13:08 PM Eastern Daylight Time			08/05/2015 06:50:20 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Advantage Plan of Illinois (HMO SNP)	01	01		1			H5779	001	0	2016	Chicago Metro Area, Northern IL and Central IL		2		2			1	3		1	5			www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5779	002	0	1	01	01	H5779_002_0	6		1	08/05/2015	2016.01	08/05/2015 09:56:31 AM Eastern Daylight Time	08/03/2015 12:18:02 PM Eastern Daylight Time	07/30/2015 04:12:26 PM Eastern Daylight Time			08/05/2015 06:56:36 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Prime (HMO)	01	01		1			H5779	002	0	2016	Chicago Metro Area, Northern IL and Central IL		2		2			2							www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	001	0	1	01	01	H5793_001_0	5		1	07/31/2015	2016.01	07/31/2015 09:54:00 PM Eastern Daylight Time	08/01/2015 10:07:24 AM Eastern Daylight Time	07/29/2015 05:55:30 PM Eastern Daylight Time			08/02/2015 07:12:48 PM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5793	001	0	2016	Inland CT		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	008	0	1	01	01	H5793_008_0	5		1	07/14/2015	2016.01	07/14/2015 05:32:01 PM Eastern Daylight Time	08/01/2015 10:08:58 AM Eastern Daylight Time	07/29/2015 05:55:50 PM Eastern Daylight Time			08/02/2015 07:12:48 PM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H5793	008	0	2016	Connecticut		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	010	0	1	01	01	H5793_010_0	5		1	07/31/2015	2016.01	07/31/2015 09:54:13 PM Eastern Daylight Time	08/01/2015 10:11:02 AM Eastern Daylight Time	07/29/2015 05:56:09 PM Eastern Daylight Time			08/02/2015 07:12:48 PM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H5793	010	0	2016	Shoreline CT		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	011	0	1	01	01	H5793_011_0	5		1	07/31/2015	2016.01	07/31/2015 09:54:50 PM Eastern Daylight Time	08/01/2015 10:11:38 AM Eastern Daylight Time	07/29/2015 05:56:28 PM Eastern Daylight Time			08/02/2015 07:12:48 PM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H5793	011	0	2016	Hartford, Litchfield & Tolland county		2		2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	801	0	1	01	01	H5793_801_0	2		1	05/29/2015	2016.01	05/29/2015 12:14:24 PM Eastern Daylight Time	07/16/2015 05:26:07 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5793	801	0	2016	Connecticut		1	6	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1	2			
H5793	802	0	1	01	01	H5793_802_0	2		1	05/29/2015	2016.01	05/29/2015 12:14:42 PM Eastern Daylight Time	07/16/2015 05:26:02 PM Eastern Daylight Time				07/16/2015 06:03:18 PM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H5793	802	0	2016	Connecticut		1	83	2			2							www.AetnaMedicareDocFind.com	http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H5810	001	0	1	01	01	H5810_001_0	7	2	1	08/05/2015	2016.01	08/05/2015 03:28:13 PM Pacific Daylight Time	08/04/2015 04:13:36 PM Pacific Daylight Time	07/30/2015 08:58:10 AM Pacific Daylight Time			08/05/2015 04:11:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5810	001	0	2016	Southern California		2		2			1	3		1	5			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	007	0	1	01	01	H5810_007_0	6	2	1	08/05/2015	2016.01	08/05/2015 03:28:22 PM Pacific Daylight Time	08/04/2015 04:13:56 PM Pacific Daylight Time	07/30/2015 08:58:36 AM Pacific Daylight Time			08/05/2015 04:11:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5810	007	0	2016	Sacramento County		2		2			1	3		1	5			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	011	0	1	01	01	H5810_011_0	7		1	08/05/2015	2016.01	08/05/2015 03:28:32 PM Pacific Daylight Time	08/04/2015 04:14:16 PM Pacific Daylight Time	07/30/2015 09:00:56 AM Pacific Daylight Time			08/05/2015 04:11:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Options (HMO)	01	01		1			H5810	011	0	2016	Inland Empire		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			
H5817	018	0	1	01	01	H5817_018_0	9		1	07/31/2015	2016.01	07/31/2015 05:04:22 PM Pacific Daylight Time	08/01/2015 06:38:28 PM Pacific Daylight Time	07/30/2015 04:31:43 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Select (HMO)	01	01		1			H5817	018	0	2016	Bexar County		2	1219	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	019	0	1	01	01	H5817_019_0	9		1	07/31/2015	2016.01	07/31/2015 05:04:03 PM Pacific Daylight Time	08/01/2015 06:39:00 PM Pacific Daylight Time	07/30/2015 04:32:21 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Select (HMO)	01	01		1			H5817	019	0	2016	El Paso County		2	630	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	020	1	1	01	01	H5817_020_1	10		1	07/31/2015	2016.01	07/31/2015 05:03:45 PM Pacific Daylight Time	08/01/2015 06:39:32 PM Pacific Daylight Time	07/30/2015 04:21:02 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H5817	020	1	2016	Select Counties in Texas	Houston Metro Area	2	4436	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	020	2	1	01	01	H5817_020_2	10		1	07/31/2015	2016.01	07/31/2015 05:03:21 PM Pacific Daylight Time	08/01/2015 06:40:05 PM Pacific Daylight Time	07/30/2015 04:21:41 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H5817	020	2	2016	Select Counties in Texas	Dallas-Fort Worth Area	2	805	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	020	3	1	01	01	H5817_020_3	10		1	07/31/2015	2016.01	07/31/2015 05:05:00 PM Pacific Daylight Time	08/01/2015 06:40:40 PM Pacific Daylight Time	07/30/2015 04:22:20 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H5817	020	3	2016	Select Counties in Texas	San Antonio Area	2	846	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	020	4	1	01	01	H5817_020_4	11		1	07/31/2015	2016.01	07/31/2015 05:06:53 PM Pacific Daylight Time	08/01/2015 06:41:13 PM Pacific Daylight Time	07/30/2015 04:22:57 PM Pacific Daylight Time			08/05/2015 02:02:48 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H5817	020	4	2016	Select Counties in Texas	El Paso Area	2	2137	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	020	5	1	01	01	H5817_020_5	10		1	07/31/2015	2016.01	07/31/2015 05:07:48 PM Pacific Daylight Time	08/01/2015 06:41:45 PM Pacific Daylight Time	07/30/2015 04:23:35 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H5817	020	5	2016	Select Counties in Texas	Lubbock County	2	1389	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	020	6	1	01	01	H5817_020_6	10		1	07/31/2015	2016.01	07/31/2015 05:08:49 PM Pacific Daylight Time	08/01/2015 06:42:17 PM Pacific Daylight Time	07/30/2015 04:24:23 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H5817	020	6	2016	Select Counties in Texas	Austin Area	2	168	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	022	0	1	01	01	H5817_022_0	9		1	07/31/2015	2016.01	07/31/2015 05:09:40 PM Pacific Daylight Time	08/01/2015 06:42:48 PM Pacific Daylight Time	07/30/2015 04:45:25 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Select (HMO)	01	01		1			H5817	022	0	2016	Travis County		2	62	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	023	0	1	01	01	H5817_023_0	9		1	07/31/2015	2016.01	07/31/2015 05:10:15 PM Pacific Daylight Time	08/01/2015 06:43:19 PM Pacific Daylight Time	07/30/2015 04:46:04 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Select (HMO)	01	01		1			H5817	023	0	2016	Harris County		2	2129	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	024	1	1	01	01	H5817_024_1	10	2	1	07/31/2015	2016.01	07/31/2015 05:10:46 PM Pacific Daylight Time	08/04/2015 07:35:22 AM Pacific Daylight Time	07/30/2015 04:39:01 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H5817	024	1	2016	Select Counties in Texas	Bexar, El Paso, Travis	2	4781	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	024	2	1	01	01	H5817_024_2	10	2	1	07/31/2015	2016.01	07/31/2015 05:11:12 PM Pacific Daylight Time	08/04/2015 07:36:03 AM Pacific Daylight Time	07/30/2015 04:39:40 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H5817	024	2	2016	Select Counties in Texas	Harris	2	6938	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5817	024	3	1	01	01	H5817_024_3	10	2	1	07/31/2015	2016.01	07/31/2015 05:12:01 PM Pacific Daylight Time	08/04/2015 07:36:53 AM Pacific Daylight Time	07/30/2015 04:40:18 PM Pacific Daylight Time			08/05/2015 11:49:58 AM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H5817	024	3	2016	Select Counties in Texas	Greater Texas	2	5540	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(800)855-2880		(800)855-2880		(711)-		(711)-		(800)855-2880		(800)855-2880		(711)-		(711)-		2					2					2	2			
H5822	001	0	1	20	08	H5822_001_0	1		1	05/20/2015	2016.01	05/20/2015 12:22:18 PM Central Daylight Time		05/18/2015 08:48:07 AM Central Daylight Time			05/20/2015 12:26:31 PM Central Daylight Time	MIDLAND CARE CONNECTION	Midland Care PACE	www.midlandcc.org	Midland Care Connection - Dual Eligibles (PACE)	08	20		1			H5822	001	0	2016	Counties: DG, JA, JF, LY, MS, NM, OS, PT, SN, WB		2		2			2								www.midlandcc.org	www.midlandcc.org									(800)491-3691		(785)232-2044	1082	(800)491-3691		(785)232-2044										(800)491-3691		(785)232-2044		(800)491-3691		(785)232-2044																
H5822	002	0	1	20	08	H5822_002_0	1		1	05/20/2015	2016.01	05/20/2015 12:22:51 PM Central Daylight Time		05/18/2015 08:48:07 AM Central Daylight Time			05/20/2015 12:26:31 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	2016	Counties: DG, JA, JF, LY, MS, NM, OS, PT, SN, WB		2		2			2								www.midlandcc.org	www.midlandcc.org									(800)491-3691		(785)232-2044		(800)491-3691		(785)232-2044										(800)491-3691		(785)232-2044		(800)491-3691		(785)232-2044																
H5823	006	0	1	01	01	H5823_006_0	7	2	1	08/05/2015	2016.01	08/05/2015 03:28:48 PM Pacific Daylight Time	08/06/2015 03:02:36 PM Pacific Daylight Time	07/30/2015 09:01:08 AM Pacific Daylight Time			08/06/2015 09:51:32 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WASHINGTON, INC.	Molina Healthcare of Washington, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5823	006	0	2016	Western and Eastern Washington		2		2			1	3		1	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	007	0	1	01	01	H5823_007_0	11	2	1	08/05/2015	2016.01	08/05/2015 03:28:56 PM Pacific Daylight Time	08/06/2015 03:36:54 PM Pacific Daylight Time	08/06/2015 02:48:40 PM Pacific Daylight Time			08/06/2015 11:02:22 PM Pacific Daylight Time	MOLINA HEALTHCARE OF WASHINGTON, INC.	Molina Healthcare of Washington, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Choice (HMO SNP)	01	01		1			H5823	007	0	2016	Pierce and Snohomish Counties		2		2			1	3		1	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	06/29/2015	2016.01	06/29/2015 09:36:52 AM Pacific Daylight Time	07/15/2015 07:17:28 AM Pacific Daylight Time				07/17/2015 11:32:31 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Plan (HMO)	01	01		1			H5826	006	0	2016	Western Washington and Spokane Counties		2	370	2			2							www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5826	008	0	1	01	01	H5826_008_0	5		1	07/23/2015	2016.01	07/23/2015 03:55:53 PM Pacific Daylight Time	08/04/2015 02:31:40 PM Pacific Daylight Time	07/31/2015 04:37:28 PM Pacific Daylight Time			08/05/2015 10:03:18 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Pharmacy Plan (HMO)	01	01		1			H5826	008	0	2016	Western Washington and Spokane Counties		2	4000	2			2							www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5826	009	0	1	01	01	H5826_009_0	5		1	07/23/2015	2016.01	07/23/2015 03:57:08 PM Pacific Daylight Time	08/04/2015 02:30:02 PM Pacific Daylight Time	07/31/2015 04:38:46 PM Pacific Daylight Time			08/05/2015 10:03:18 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Pharmacy Plan (HMO)	01	01		1			H5826	009	0	2016	Eastern and Western Washington State		2	3800	2			2							www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5826	010	0	1	01	01	H5826_010_0	5		1	08/04/2015	2016.01	08/04/2015 02:05:36 PM Pacific Daylight Time	08/05/2015 08:53:38 AM Pacific Daylight Time	07/31/2015 05:00:32 PM Pacific Daylight Time			08/05/2015 10:03:18 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Extra Plan (HMO)	01	01		1			H5826	010	0	2016	Western Washington, Spokane and Yakima Counties		2	2700	2			2							www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5826	014	0	1	01	01	H5826_014_0	4	2	1	08/04/2015	2016.01	08/04/2015 02:05:08 PM Pacific Daylight Time	08/04/2015 02:27:38 PM Pacific Daylight Time	08/03/2015 10:07:00 PM Pacific Daylight Time			08/05/2015 10:03:18 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Special Needs Plan (HMO SNP)	01	01		1			H5826	014	0	2016	Eastern and Western Washington State		2	7200	2			1	3		1	5			www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5852	001	0	1	01	01	H5852_001_0	10		1	08/04/2015	2016.01	08/04/2015 02:39:08 PM Pacific Daylight Time	08/05/2015 04:33:10 PM Pacific Daylight Time	08/05/2015 04:33:10 PM Pacific Daylight Time			08/05/2015 04:45:18 PM Pacific Daylight Time	AIDS HEALTHCARE FOUNDATION	AHF	www.php-ca.org	PHP (HMO SNP)	01	01		1			H5852	001	0	2016	Los Angeles County, California		2	900	2			1	4		1		00000000001000000000		www.php-ca.org/consider-php/provider-pharmacy-networks	www.php-ca.org/for-members/drug-benefit/formulary	www.php-ca.org/consider-php/provider-pharmacy-networks	(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	8		1	07/31/2015	2016.01	07/31/2015 10:38:55 PM Eastern Daylight Time	08/03/2015 04:17:05 PM Eastern Daylight Time	07/30/2015 06:27:44 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H5854	007	0	2016	Hartford County		2	445	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	008	0	1	01	01	H5854_008_0	7	2	1	07/31/2015	2016.01	07/31/2015 01:58:42 PM Eastern Daylight Time	08/01/2015 09:46:04 PM Eastern Daylight Time	07/30/2015 07:33:13 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H5854	008	0	2016	Select Counties in Connecticut		2	3397	2			1	3		1	5			www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)316-0358		(844)316-0358		(866)673-4157		(866)673-4157		(844)316-0358		(844)316-0358		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	009	0	1	01	01	H5854_009_0	9		1	07/31/2015	2016.01	07/31/2015 10:39:02 PM Eastern Daylight Time	08/01/2015 09:46:37 PM Eastern Daylight Time	07/30/2015 06:38:52 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H5854	009	0	2016	Fairfield, Litchfield, New Haven and Windham		2	1404	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	801	0	1	01	01	H5854_801_0	6		1	05/20/2015	2016.01	05/20/2015 11:30:44 AM Pacific Daylight Time	06/18/2015 03:11:44 PM Pacific Daylight Time				06/18/2015 03:24:37 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H5854	801	0	2016	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H5854	803	0	1	01	01	H5854_803_0	6		1	05/20/2015	2016.01	05/20/2015 11:30:47 AM Pacific Daylight Time	06/18/2015 03:11:55 PM Pacific Daylight Time				06/18/2015 03:24:37 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H5854	803	0	2016	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H5859	001	0	1	02	01	H5859_001_0	4	2	1	08/04/2015	2016.01	08/04/2015 09:18:37 PM Pacific Daylight Time	08/04/2015 09:45:42 PM Pacific Daylight Time	08/04/2015 09:45:42 PM Pacific Daylight Time			08/04/2015 09:52:16 PM Pacific Daylight Time	HEALTH PLAN OF CAREOREGON, INC.	CareOregon Advantage	www.careoregonadvantage.org	CareOregon Advantage Plus (HMO-POS SNP)	01	02		1			H5859	001	0	2016	Portland/Salem Area, Northwest and Southern Oregon		2	126588	2			1	3		1	3		2	http://www.careoregonadvantage.org	http://www.careoregonadvantage.org/member-resources/rx-and-drug-information/are-my-drugs-covered-	http://www.careoregonadvantage.org/member-resources/rx-and-drug-information	(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H5859	003	0	1	02	01	H5859_003_0	4		1	08/04/2015	2016.01	08/04/2015 08:45:27 PM Pacific Daylight Time	08/04/2015 09:45:42 PM Pacific Daylight Time	08/12/2015 03:10:10 PM Pacific Daylight Time			08/12/2015 03:32:58 PM Pacific Daylight Time	HEALTH PLAN OF CAREOREGON, INC.	CareOregon Advantage	www.careoregonadvantage.org	CareOregon Advantage Star (HMO-POS)	01	02		1			H5859	003	0	2016	Portland/Salem Area, Northwest and Southern Oregon		2	20544	2			2							http://www.careoregonadvantage.org	http://www.careoregonadvantage.org/member-resources/rx-and-drug-information/are-my-drugs-covered-	http://www.careoregonadvantage.org/member-resources/rx-and-drug-information	(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H5883	001	1	1	02	01	H5883_001_1	5		1	07/23/2015	2016.01	07/23/2015 03:56:46 PM Eastern Daylight Time	07/13/2015 11:25:25 AM Eastern Daylight Time				07/23/2015 06:39:31 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	1	2016	Michigan	Region 1	2	310	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	2	1	02	01	H5883_001_2	5		1	07/23/2015	2016.01	07/23/2015 04:02:12 PM Eastern Daylight Time	07/13/2015 11:26:02 AM Eastern Daylight Time				07/23/2015 06:39:31 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	2	2016	Michigan	Region 2	2	150	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	3	1	02	01	H5883_001_3	5		1	07/23/2015	2016.01	07/23/2015 04:02:51 PM Eastern Daylight Time	07/13/2015 11:26:39 AM Eastern Daylight Time				07/23/2015 06:39:31 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	3	2016	Michigan	Region 3	2	55	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	4	1	02	01	H5883_001_4	5		1	07/23/2015	2016.01	07/23/2015 04:03:32 PM Eastern Daylight Time	07/13/2015 11:27:16 AM Eastern Daylight Time				07/23/2015 06:39:31 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	4	2016	Michigan	Region 4	2	187	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	001	5	1	02	01	H5883_001_5	5		1	07/23/2015	2016.01	07/23/2015 04:04:28 PM Eastern Daylight Time	07/13/2015 11:27:53 AM Eastern Daylight Time				07/23/2015 06:39:31 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	5	2016	Michigan	Region 5	2	348	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	002	1	1	02	01	H5883_002_1	6		1	07/23/2015	2016.01	07/23/2015 03:57:23 PM Eastern Daylight Time	08/03/2015 02:02:03 PM Eastern Daylight Time	07/30/2015 02:29:16 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 1	2	5709	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	2	1	02	01	H5883_002_2	6		1	07/23/2015	2016.01	07/23/2015 04:05:11 PM Eastern Daylight Time	08/03/2015 02:02:40 PM Eastern Daylight Time	07/30/2015 02:29:44 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 2	2	2917	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	3	1	02	01	H5883_002_3	6		1	07/23/2015	2016.01	07/23/2015 04:05:50 PM Eastern Daylight Time	08/03/2015 02:03:18 PM Eastern Daylight Time	07/30/2015 02:30:09 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 3	2	1222	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	4	1	02	01	H5883_002_4	6		1	07/23/2015	2016.01	07/23/2015 04:06:28 PM Eastern Daylight Time	08/03/2015 02:03:56 PM Eastern Daylight Time	07/30/2015 02:30:22 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 4	2	4040	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	002	7	1	02	01	H5883_002_7	6		1	07/23/2015	2016.01	07/23/2015 04:07:18 PM Eastern Daylight Time	08/03/2015 02:04:34 PM Eastern Daylight Time	07/30/2015 02:30:36 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 5	2	7952	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	1	1	02	01	H5883_003_1	6		1	07/23/2015	2016.01	07/23/2015 03:55:01 PM Eastern Daylight Time	08/03/2015 02:05:12 PM Eastern Daylight Time	07/30/2015 02:31:06 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 1	2	353	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	2	1	02	01	H5883_003_2	6		1	07/23/2015	2016.01	07/23/2015 04:08:10 PM Eastern Daylight Time	08/03/2015 02:05:49 PM Eastern Daylight Time	07/30/2015 02:50:47 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 2	2	323	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	3	1	02	01	H5883_003_3	6		1	07/23/2015	2016.01	07/23/2015 04:08:55 PM Eastern Daylight Time	08/03/2015 02:06:27 PM Eastern Daylight Time	07/30/2015 02:51:08 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 3	2	110	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	4	1	02	01	H5883_003_4	6		1	07/23/2015	2016.01	07/23/2015 04:09:36 PM Eastern Daylight Time	08/03/2015 02:07:04 PM Eastern Daylight Time	07/30/2015 02:51:22 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 4	2	410	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	003	5	1	02	01	H5883_003_5	7		1	07/23/2015	2016.01	07/23/2015 04:10:14 PM Eastern Daylight Time	08/03/2015 02:07:42 PM Eastern Daylight Time	07/30/2015 02:51:38 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Michigan	Region 5	2	1570	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	1	1	02	01	H5883_004_1	6		1	08/04/2015	2016.01	08/04/2015 03:38:45 PM Eastern Daylight Time	08/03/2015 02:08:20 PM Eastern Daylight Time	07/30/2015 02:51:54 PM Eastern Daylight Time			08/04/2015 04:48:30 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	1	2016	Michigan	Region 1	2	2616	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	2	1	02	01	H5883_004_2	6		1	08/04/2015	2016.01	08/04/2015 03:38:52 PM Eastern Daylight Time	08/03/2015 02:08:58 PM Eastern Daylight Time	07/30/2015 02:53:49 PM Eastern Daylight Time			08/04/2015 04:48:30 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	2	2016	Michigan	Region 2	2	2491	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	3	1	02	01	H5883_004_3	6		1	08/04/2015	2016.01	08/04/2015 03:38:59 PM Eastern Daylight Time	08/03/2015 02:09:36 PM Eastern Daylight Time	07/30/2015 02:54:03 PM Eastern Daylight Time			08/04/2015 04:48:30 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	3	2016	Michigan	Region 3	2	1262	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	4	1	02	01	H5883_004_4	6		1	08/04/2015	2016.01	08/04/2015 03:39:05 PM Eastern Daylight Time	08/03/2015 02:10:14 PM Eastern Daylight Time	07/30/2015 02:54:17 PM Eastern Daylight Time			08/04/2015 04:48:30 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	4	2016	Michigan	Region 4	2	2545	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	004	5	1	02	01	H5883_004_5	6		1	08/04/2015	2016.01	08/04/2015 03:39:13 PM Eastern Daylight Time	08/03/2015 02:10:52 PM Eastern Daylight Time	07/30/2015 02:54:33 PM Eastern Daylight Time			08/04/2015 04:48:30 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	5	2016	Michigan	Region 5	2	6653	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	006	0	1	01	01	H5883_006_0	7		1	07/23/2015	2016.01	07/23/2015 04:41:23 PM Eastern Daylight Time	08/03/2015 02:11:30 PM Eastern Daylight Time	07/30/2015 02:54:51 PM Eastern Daylight Time			08/04/2015 04:48:30 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO MyChoice Wellness (HMO)	01	01		1			H5883	006	0	2016	Kent, Muskegon and Oceana Counties		2	3285	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	007	0	1	01	01	H5883_007_0	8		1	07/23/2015	2016.01	07/23/2015 04:41:42 PM Eastern Daylight Time	08/04/2015 12:25:06 PM Eastern Daylight Time	07/30/2015 02:55:07 PM Eastern Daylight Time			08/04/2015 04:48:30 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	2016	Gen, Kzoo, Liv, Macomb, Oak, St Clair, Wash, Wayne		2	5317	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5883	801	0	1	02	01	H5883_801_0	3		1	05/29/2015	2016.01	05/29/2015 05:08:19 PM Eastern Daylight Time	06/01/2015 06:22:38 PM Eastern Daylight Time				06/01/2015 08:50:04 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	2016	Employer Group		1	20667	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1	2			
H5883	805	0	1	02	01	H5883_805_0	4		1	05/29/2015	2016.01	05/29/2015 05:07:51 PM Eastern Daylight Time	07/13/2015 11:38:24 AM Eastern Daylight Time				07/15/2015 03:54:07 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	2016	Employer Group		1	5475	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1	2			
H5883	807	0	1	02	01	H5883_807_0	4		1	05/29/2015	2016.01	05/29/2015 05:33:12 PM Eastern Daylight Time	07/13/2015 02:53:20 PM Eastern Daylight Time				07/17/2015 07:33:25 AM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage (HMO-POS)	01	02		1			H5883	807	0	2016	Employer Group		1	1200	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9d;12;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1	2			
H5902	001	0	1	20	08	H5902_001_0	1		1	05/20/2015	2016.01	05/20/2015 10:29:41 AM Eastern Daylight Time		05/18/2015 02:44:08 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Ebensburg	www.seniorlifeebensburg.com	Senior LIFE Altoona Dual Eligible (PACE)	08	20		1			H5902	001	0	2016	Senior LIFE Blair Indiana Cambria County Dual		2	195	2			2								NA	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5902	002	0	1	20	08	H5902_002_0	1		1	05/20/2015	2016.01	05/20/2015 10:29:54 AM Eastern Daylight Time		05/18/2015 02:44:08 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Ebensburg	www.seniorlifeebensburg.com	Senior LIFE Altoona Medicare Only (PACE)	08	20		1			H5902	002	0	2016	Senior LIFE Balir Indiana Cambria County MC Only		2	1	2			2								NA	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5926	001	0	1	01	01	H5926_001_0	6	2	1	08/05/2015	2016.01	08/05/2015 03:29:06 PM Pacific Daylight Time	08/04/2015 04:14:36 PM Pacific Daylight Time	07/30/2015 09:01:30 AM Pacific Daylight Time			08/05/2015 04:11:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5926	001	0	2016	East Michigan and West Michigan		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-3072		(800)665-3072		(866)403-8293		(866)403-8293		(800)665-3072		(800)665-3072		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	001	0	1	01	01	H5928_001_0	8	2	1	07/31/2015	2016.01	07/31/2015 01:39:49 PM Pacific Daylight Time	08/03/2015 10:52:06 AM Pacific Daylight Time	07/31/2015 01:51:51 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st TotalDual Plan (HMO SNP)	01	01		1			H5928	001	0	2016	Los Angeles County		2	1350	2			1	3		1	4			www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	004	0	1	01	01	H5928_004_0	8		1	07/31/2015	2016.01	07/31/2015 01:48:49 PM Pacific Daylight Time	08/03/2015 10:53:47 AM Pacific Daylight Time	07/31/2015 01:53:13 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	004	0	2016	Los Angeles and Orange Counties		2	21000	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	005	0	1	01	01	H5928_005_0	12	2	1	07/31/2015	2016.01	07/31/2015 01:50:03 PM Pacific Daylight Time	08/03/2015 10:55:30 AM Pacific Daylight Time	07/31/2015 01:54:39 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st TotalDual Plan (HMO SNP)	01	01		1			H5928	005	0	2016	Orange and San Bernardino Counties		2	2850	2			1	3		1	4			www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	009	0	1	01	01	H5928_009_0	8	2	1	07/31/2015	2016.01	07/31/2015 01:51:07 PM Pacific Daylight Time	08/03/2015 10:56:23 AM Pacific Daylight Time	07/31/2015 01:57:38 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st TotalDual Plan (HMO SNP)	01	01		1			H5928	009	0	2016	San Diego County		2	1350	2			1	3		1	4			www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	010	0	1	01	01	H5928_010_0	8		1	07/31/2015	2016.01	07/31/2015 01:52:28 PM Pacific Daylight Time	08/03/2015 10:57:18 AM Pacific Daylight Time	07/31/2015 02:02:04 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	010	0	2016	San Diego County		2	9300	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	012	0	1	01	01	H5928_012_0	8		1	07/31/2015	2016.01	07/31/2015 01:54:23 PM Pacific Daylight Time	08/03/2015 12:15:29 PM Pacific Daylight Time	07/31/2015 02:04:32 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	012	0	2016	San Bernardino and Riverside Counties		2	2600	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	016	0	1	01	01	H5928_016_0	9		1	08/10/2015	2016.01	08/10/2015 10:49:34 AM Pacific Daylight Time	08/10/2015 11:24:53 AM Pacific Daylight Time	07/31/2015 02:05:52 PM Pacific Daylight Time			08/10/2015 11:55:32 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	016	0	2016	Santa Clara County		2	4500	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	020	0	1	01	01	H5928_020_0	7		1	07/17/2015	2016.01	07/17/2015 03:27:06 PM Pacific Daylight Time	08/03/2015 11:00:39 AM Pacific Daylight Time	07/31/2015 02:09:08 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	020	0	2016	San Joaquin County		2	1400	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	022	0	1	01	01	H5928_022_0	7		1	07/17/2015	2016.01	07/17/2015 03:27:30 PM Pacific Daylight Time	08/03/2015 11:01:33 AM Pacific Daylight Time	07/31/2015 02:10:22 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	022	0	2016	Stanislaus County		2	1800	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	024	0	1	01	01	H5928_024_0	9		1	07/21/2015	2016.01	07/21/2015 11:30:34 AM Pacific Daylight Time	08/03/2015 11:02:43 AM Pacific Daylight Time	07/31/2015 02:12:35 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	024	0	2016	Alameda County		2	1200	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	025	0	1	01	01	H5928_025_0	10	2	1	07/31/2015	2016.01	07/31/2015 02:28:48 PM Pacific Daylight Time	08/03/2015 11:03:33 AM Pacific Daylight Time	07/31/2015 02:15:53 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st TotalDual Plan (HMO SNP)	01	01		1			H5928	025	0	2016	Santa Clara, San Francisco & Alameda Counties		2	2850	2			1	3		1	4			www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	037	0	1	01	01	H5928_037_0	10		1	08/03/2015	2016.01	08/03/2015 12:18:54 PM Pacific Daylight Time	08/03/2015 11:04:44 AM Pacific Daylight Time	07/31/2015 02:17:25 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Coordinated Choice Plan (HMO)	01	01		1			H5928	037	0	2016	LA, OR, SD, SB, RV, SC, FR, ME		2	4700	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	038	0	1	01	01	H5928_038_0	8		1	07/31/2015	2016.01	07/31/2015 02:31:05 PM Pacific Daylight Time	08/03/2015 11:05:33 AM Pacific Daylight Time	07/31/2015 02:20:05 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	038	0	2016	El Paso County		2	5700	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	042	0	1	01	01	H5928_042_0	7		1	07/17/2015	2016.01	07/17/2015 03:31:13 PM Pacific Daylight Time	08/03/2015 11:08:30 AM Pacific Daylight Time	07/31/2015 02:23:42 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	042	0	2016	San Francisco		2	1070	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	044	0	1	01	01	H5928_044_0	7		1	07/31/2015	2016.01	07/31/2015 02:32:12 PM Pacific Daylight Time	08/03/2015 11:09:52 AM Pacific Daylight Time	07/31/2015 02:25:37 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	044	0	2016	Fresno County		2	1179	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	046	0	1	01	01	H5928_046_0	7		1	07/31/2015	2016.01	07/31/2015 02:32:57 PM Pacific Daylight Time	08/03/2015 11:11:05 AM Pacific Daylight Time	07/31/2015 02:27:44 PM Pacific Daylight Time			08/04/2015 09:03:26 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	046	0	2016	Merced County		2	1435	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5928	047	0	1	01	01	H5928_047_0	11		1	07/31/2015	2016.01	07/31/2015 02:33:43 PM Pacific Daylight Time	08/03/2015 11:13:08 AM Pacific Daylight Time	07/31/2015 02:29:44 PM Pacific Daylight Time			08/03/2015 03:25:17 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Coordinated Choice Plan (HMO)	01	01		1			H5928	047	0	2016	El Paso County		2	371	2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5932	001	0	1	01	01	H5932_001_0	11	2	1	08/04/2015	2016.01	08/04/2015 11:29:29 AM Eastern Daylight Time	08/05/2015 03:02:50 PM Eastern Daylight Time	08/05/2015 03:02:55 PM Eastern Daylight Time			08/05/2015 05:14:11 PM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H5932	001	0	2016	Pennsylvania Counties		2	43980	2			1	3		1	5			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5932	007	0	1	01	01	H5932_007_0	13		1	08/04/2015	2016.01	08/04/2015 11:30:06 AM Eastern Daylight Time	08/05/2015 03:02:56 PM Eastern Daylight Time	08/05/2015 03:02:57 PM Eastern Daylight Time			08/05/2015 03:17:01 PM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Gold (HMO SNP)	01	01		1			H5932	007	0	2016	Pennsylvania Counties		2	1447	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5932	008	0	1	01	01	H5932_008_0	11		1	08/04/2015	2016.01	08/04/2015 11:30:33 AM Eastern Daylight Time	08/05/2015 03:02:58 PM Eastern Daylight Time	08/05/2015 03:02:59 PM Eastern Daylight Time			08/05/2015 03:21:26 PM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Platinum (HMO SNP)	01	01		1			H5932	008	0	2016	Pennsylvania Counties		2	5831	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5932	009	0	1	01	01	H5932_009_0	10	2	1	08/04/2015	2016.01	08/04/2015 11:30:51 AM Eastern Daylight Time	08/05/2015 03:02:59 PM Eastern Daylight Time	08/05/2015 03:03:00 PM Eastern Daylight Time			08/05/2015 03:24:49 PM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H5932	009	0	2016	Pennsylvania Counties		2	3183	2			1	3		1	4			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5934	001	0	1	20	08	H5934_001_0	2		1	05/19/2015	2016.01	05/19/2015 08:58:00 AM Eastern Daylight Time		05/15/2015 11:54:47 AM Eastern Daylight Time			05/27/2015 05:04:10 PM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	http://hopehcs.org/pace	Hope PACE (PACE)	08	20		1			H5934	001	0	2016	Lee, Charlotte and Collier Counties Florida		2		2			2								hopehcs.org/pace	carekinesis.com									(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400										(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400																
H5934	002	0	1	20	08	H5934_002_0	2		1	05/19/2015	2016.01	05/19/2015 08:58:46 AM Eastern Daylight Time		05/26/2015 12:25:54 PM Eastern Daylight Time			05/27/2015 05:04:10 PM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	http://hopehcs.org/pace	Hope PACE (PACE)	08	20		1			H5934	002	0	2016	Lee, Charlotte and Collier Counties Florida		2		2			2								hopehcs.org/pace	carekinesis.com									(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400										(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400																
H5938	001	0	1	01	01	H5938_001_0	9		1	07/08/2015	2016.01	07/08/2015 12:19:56 PM Eastern Daylight Time	08/05/2015 05:44:34 PM Eastern Daylight Time	08/05/2015 05:44:50 PM Eastern Daylight Time			08/05/2015 06:04:26 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	2016	Leon and surrounding counties		2	7708	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	9		1	07/08/2015	2016.01	07/08/2015 12:20:43 PM Eastern Daylight Time	08/05/2015 05:45:04 PM Eastern Daylight Time	08/05/2015 05:45:14 PM Eastern Daylight Time			08/05/2015 06:04:26 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	2016	Leon and surrounding counties		2	2274	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	7		1	05/18/2015	2016.01	05/18/2015 02:30:31 PM Eastern Daylight Time	05/31/2015 10:03:16 AM Eastern Daylight Time				05/31/2015 11:24:52 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	802	0	2016	Leon and surrounding counties		1	7303	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;5;6;7e;9c;11a;11b;15;16b;	1	1a;1b;2;5;6;7d;7g;8b1;9c;9d;14a;14d;14e;16b;	1					1	2			
H5938	803	0	1	01	01	H5938_803_0	7		1	05/18/2015	2016.01	05/18/2015 02:26:24 PM Eastern Daylight Time	05/31/2015 10:05:16 AM Eastern Daylight Time				05/31/2015 11:24:52 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	803	0	2016	Leon and surrounding counties		1	878	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;5;6;7e;9c;11a;11b;15;16b;	1	1a;1b;2;5;6;7d;7g;8b1;9c;9d;14a;14d;14e;16b;	1					1	2			
H5938	804	0	1	01	01	H5938_804_0	7		1	04/17/2015	2016.01	04/17/2015 04:11:40 PM Eastern Daylight Time	05/31/2015 10:06:05 AM Eastern Daylight Time				05/31/2015 11:24:52 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	804	0	2016	Leon and surrounding counties		1	1481	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;5;6;7e;11a;11b;15;16b;	1	1a;1b;2;5;6;7g;8b1;9c;9d;14a;14d;14e;16b;	1					1	2			
H5943	001	0	1	02	01	H5943_001_0	5		1	07/31/2015	2016.01	07/31/2015 01:16:19 PM Pacific Daylight Time		07/29/2015 01:55:00 PM Pacific Daylight Time		08/03/2015 02:22:42 PM Pacific Daylight Time	08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS SNP)	01	02		1			H5943	001	0	2016	Riverside and  San Bernardino Counties		2		2			1	4		1		00000000100000000000		www.villagehealthca.com	www.villagehealthca.com	www.villagehealthca.com	(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5943	002	0	1	02	01	H5943_002_0	4		1	08/05/2015	2016.01	08/05/2015 11:40:56 AM Pacific Daylight Time		07/29/2015 01:51:02 PM Pacific Daylight Time		08/03/2015 02:23:28 PM Pacific Daylight Time	08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS SNP)	01	02		1			H5943	002	0	2016	Los Angeles and Orange Counties		2		2			1	4		1		00000000100000000000		www.villagehealthca.com	www.villagehealthca.com	www.villagehealthca.com	(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5945	001	0	1	01	01	H5945_001_0	7		1	07/10/2015	2016.01	07/10/2015 11:23:00 AM Pacific Daylight Time	08/05/2015 01:31:23 PM Pacific Daylight Time	08/05/2015 01:31:24 PM Pacific Daylight Time			08/05/2015 01:38:54 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencehealthplan.com/medicare	Prominence Value (HMO)	01	01		1			H5945	001	0	2016	Northern Nevada		2	868	1	1		2							www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(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	7		1	07/10/2015	2016.01	07/10/2015 11:23:38 AM Pacific Daylight Time	08/05/2015 01:31:26 PM Pacific Daylight Time	08/05/2015 01:31:27 PM Pacific Daylight Time			08/05/2015 01:48:53 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencehealthplan.com/medicare	Prominence Plus (HMO)	01	01		1			H5945	002	0	2016	Washoe County		2	3372	1	1		2							www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5945	801	0	1	01	01	H5945_801_0	2		1	05/30/2015	2016.01	05/30/2015 04:23:17 PM Pacific Daylight Time	05/30/2015 04:21:59 PM Pacific Daylight Time				05/30/2015 04:34:26 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencehealthplan.com/medicare	Prominence Health Plan (HMO)	01	01		1			H5945	801	0	2016	National		1	1	1	1		2							www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;9d;10a;11a;11b;12;15;16b;	2		1					1	2			
H5945	802	0	1	01	01	H5945_802_0	2		1	05/30/2015	2016.01	05/30/2015 04:23:24 PM Pacific Daylight Time	05/30/2015 04:22:01 PM Pacific Daylight Time				05/30/2015 04:34:26 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencehealthplan.com/medicare	Prominence Health Plan (HMO)	01	01		1			H5945	802	0	2016	National		1	1	1	1		2							www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;9d;10a;11a;11b;12;15;16b;	2		1					1	2			
H5945	803	0	1	01	01	H5945_803_0	2		1	05/30/2015	2016.01	05/30/2015 04:23:30 PM Pacific Daylight Time	05/30/2015 04:22:02 PM Pacific Daylight Time				05/30/2015 04:34:26 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencehealthplan.com/medicare	Prominence Health Plan (HMO)	01	01		1			H5945	803	0	2016	National		1	1	1	1		2							www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;9d;10a;11a;11b;12;15;16b;	2		1					1	2			
H5969	002	0	1	01	01	H5969_002_0	8	2	1	08/10/2015	2016.01	08/10/2015 10:24:13 AM Hawaiian Standard Time	07/30/2015 03:23:03 PM Hawaiian Standard Time	07/30/2015 03:23:04 PM Hawaiian Standard Time			08/10/2015 10:27:26 AM Hawaiian Standard Time	ALOHACARE	AlohaCare	AlohaCare.org	AlohaCare Advantage Plus (HMO SNP)	01	01		1			H5969	002	0	2016	State of Hawaii		2	834	2			1	3		1	3		1	AlohaCare.org	AlohaCare.org	http://www.AlohaCare.org/providersearch	(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	3		1	07/07/2015	2016.01	07/07/2015 04:04:06 PM Eastern Daylight Time	08/03/2015 03:16:59 PM Eastern Daylight Time	07/29/2015 11:46:48 PM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-001 (PPO)	01	04		1			H5970	001	0	2016	Southern Tier Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	002	0	1	04	01	H5970_002_0	3		1	07/08/2015	2016.01	07/08/2015 04:16:52 PM Eastern Daylight Time	08/03/2015 10:55:01 AM Eastern Daylight Time	07/29/2015 11:47:22 PM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-002 (PPO)	01	04		1			H5970	002	0	2016	Central New York Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	004	0	1	04	01	H5970_004_0	3		1	07/08/2015	2016.01	07/08/2015 04:20:36 PM Eastern Daylight Time	08/03/2015 10:38:31 AM Eastern Daylight Time	07/29/2015 11:47:58 PM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-004 (PPO)	01	04		1			H5970	004	0	2016	Upstate Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	008	0	1	04	01	H5970_008_0	3		1	07/07/2015	2016.01	07/07/2015 04:04:54 PM Eastern Daylight Time	08/03/2015 10:45:47 AM Eastern Daylight Time	07/29/2015 11:48:34 PM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-008 (PPO)	01	04		1			H5970	008	0	2016	Capital District Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	801	0	1	04	01	H5970_801_0	1		1	05/12/2015	2016.01	05/13/2015 11:42:22 AM Eastern Daylight Time	05/29/2015 10:59:12 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5970	801	0	2016	State of New York		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5970	802	0	1	04	01	H5970_802_0	1		1	05/13/2015	2016.01	05/13/2015 12:34:16 PM Eastern Daylight Time	05/29/2015 10:59:40 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5970	802	0	2016	State of New York		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5970	803	0	1	04	01	H5970_803_0	1		1	05/12/2015	2016.01	05/13/2015 11:43:39 AM Eastern Daylight Time	05/29/2015 11:00:11 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H5970	803	0	2016	State of New York		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5970	805	0	2	04	01	H5970_805_0	1		1	05/14/2015	2016.01	05/14/2015 08:23:18 AM Eastern Daylight Time	05/29/2015 11:05:11 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5970	805	0	2016	State of New York		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5970	806	0	2	04	01	H5970_806_0	1		1	05/14/2015	2016.01	05/14/2015 08:15:39 AM Eastern Daylight Time	05/29/2015 11:05:39 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5970	806	0	2016	State of New York		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5970	807	0	2	04	01	H5970_807_0	1		1	05/14/2015	2016.01	05/14/2015 08:26:31 AM Eastern Daylight Time	05/29/2015 11:06:07 AM Eastern Daylight Time				05/29/2015 11:33:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H5970	807	0	2016	State of New York		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H5978	001	0	1	20	08	H5978_001_0	1		1	05/20/2015	2016.01	05/20/2015 10:31:08 AM Eastern Daylight Time		05/18/2015 02:42:07 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIOR LIFE LEHIGH VALLEY, INC.	PHI LIFE dba everyday LIFE	www.seniorlifepa.com	Senior LIFE Lehigh Valley Dual Eligible (PACE)	08	20		1			H5978	001	0	2016	Senior LIFE Northampton Lehigh County Dual		2	170	2			2								NA	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5978	002	0	1	20	08	H5978_002_0	1		1	05/20/2015	2016.01	05/20/2015 10:31:20 AM Eastern Daylight Time		05/18/2015 02:42:07 PM Eastern Daylight Time			05/20/2015 11:05:02 AM Eastern Daylight Time	SENIOR LIFE LEHIGH VALLEY, INC.	PHI LIFE dba everyday LIFE	www.everydaylifecenters.org	Senior LIFE Lehigh Valley MC Only (PACE)	08	20		1			H5978	002	0	2016	Senior LIFE Lehigh and Northampton County MC Only		2	1	2			2								NA	http://granerx.com/									(877)998-5433	22102	(814)535-6000	22102	(877)998-5433	22102	(814)535-6000	22102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5985	001	0	1	01	01	H5985_001_0	8		1	08/05/2015	2016.01	08/05/2015 11:48:25 AM US Mountain Standard Time	08/05/2015 04:44:58 PM US Mountain Standard Time	08/05/2015 04:45:06 PM US Mountain Standard Time			08/05/2015 04:48:59 PM US Mountain Standard Time	PHOENIX HEALTH PLANS, INC.	Phoenix Health Plans	www.phoenixhealthplans.com	Phoenix Advantage (HMO)	01	01		1			H5985	001	0	2016	Arizona		2	3000	2			2							www.phoenixhealthplans.com/members/find-a-doctor-pharmacy	www.phoenixhealthplans.com	www.phoenixhealthplans.com	(888)864-1114		(602)824-3900		(888)864-1114		(602)824-3900		(888)864-1114		(602)824-3900		(888)864-1114		(602)824-3900		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		2					2					2	2			
H5985	002	0	1	01	01	H5985_002_0	12	2	1	08/05/2015	2016.01	08/05/2015 11:36:07 AM US Mountain Standard Time	08/05/2015 04:45:32 PM US Mountain Standard Time	08/05/2015 04:45:43 PM US Mountain Standard Time			08/05/2015 04:52:52 PM US Mountain Standard Time	PHOENIX HEALTH PLANS, INC.	Phoenix Health Plans	www.phoenixhealthplans.com	Phoenix Advantage Plus (HMO SNP)	01	01		1			H5985	002	0	2016	Maricopa County		2	1300	2			1	3		1	4			www.phoenixhealthplans.com/members/find-a-doctor-pharmacy	www.phoenixhealthplans.com	www.phoenixhealthplans.com	(888)864-1114		(602)824-3900		(888)864-1114		(602)824-3900		(888)864-1114		(602)824-3900		(888)864-1114		(602)824-3900		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		2					2					2	2			
H5985	005	0	1	01	01	H5985_005_0	9		1	08/05/2015	2016.01	08/05/2015 11:43:28 AM US Mountain Standard Time	08/05/2015 04:46:23 PM US Mountain Standard Time	08/05/2015 04:46:33 PM US Mountain Standard Time			08/05/2015 04:55:47 PM US Mountain Standard Time	PHOENIX HEALTH PLANS, INC.	Phoenix Health Plans	www.phoenixhealthplans.com	Phoenix Advantage Select (HMO)	01	01		1			H5985	005	0	2016	Arizona		2	900	2			2							www.phoenixhealthplans.com/members/find-a-doctor-pharmacy	www.phoenixhealthplans.com	www.phoenixhealthplans.com	(888)864-1114		(602)824-3900		(888)864-1114		(602)824-3900		(888)864-1114		(602)824-3900		(888)864-1114		(602)824-3900		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		2					2					2	2			
H5989	002	0	1	01	01	H5989_002_0	4		1	08/03/2015	2016.01	08/03/2015 09:31:53 AM Central Daylight Time	08/04/2015 04:24:21 PM Central Daylight Time	07/30/2015 04:46:40 PM Central Daylight Time			08/05/2015 04:15:50 PM Central Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight Healthcare, Inc.	www.centerlighthealthcare.org	CenterLight Healthcare Direct Complete Plan (HMO SNP)	01	01		1			H5989	002	0	2016	NYC, LI, Westchester and Rockland Counties		2	1421	2			1	1	3	1				www.centerlighthealthcare.org	http://www.centerlighthealthcare.org	http://www.centerlighthealthcare.org	(877)226-8500		(347)640-6280		(877)226-8500		(347)640-6280		(800)935-7195		(800)935-7195		(800)935-7195		(800)935-7195		(711)-		(711)-		(711)-		(711)-		(800)759-1089		(800)759-1089		(800)759-1089		(800)759-1089		2					2					2	2			
H5991	001	0	1	01	01	H5991_001_0	6	2	1	08/03/2015	2016.01	08/03/2015 11:50:41 AM Eastern Daylight Time	07/31/2015 01:47:04 PM Eastern Daylight Time	07/31/2015 11:51:04 AM Eastern Daylight Time			08/03/2015 12:01:55 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Ultimate (HMO SNP)	01	01		1			H5991	001	0	2016	NYC, Long Island, Westchester, Rockland, Orange		2	5723	2			1	3		1	3		1	www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2	2			
H5991	002	0	1	01	01	H5991_002_0	6	2	1	08/03/2015	2016.01	08/03/2015 11:50:35 AM Eastern Daylight Time	07/31/2015 07:06:42 PM Eastern Daylight Time	07/31/2015 11:51:34 AM Eastern Daylight Time			08/03/2015 12:01:55 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Solutions (HMO SNP)	01	01		1			H5991	002	0	2016	NYC, Long Island, Westchester, Rockland, Orange		2	1440	2			1	3		1	2			www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2	2			
H5991	003	0	1	01	01	H5991_003_0	6		1	08/03/2015	2016.01	08/03/2015 11:50:46 AM Eastern Daylight Time	07/31/2015 11:48:30 AM Eastern Daylight Time	08/03/2015 08:00:30 AM Eastern Daylight Time			08/03/2015 12:01:55 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Passport Essentials (HMO)	01	01		1			H5991	003	0	2016	Counties:NY,RO,WE,NA,SU,OR		2	2525	2			2							www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2	2			
H5991	004	0	1	01	01	H5991_004_0	6		1	08/03/2015	2016.01	08/03/2015 11:50:55 AM Eastern Daylight Time	07/31/2015 11:49:16 AM Eastern Daylight Time	07/31/2015 11:52:28 AM Eastern Daylight Time			08/03/2015 12:01:55 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Passport Select (HMO)	01	01		1			H5991	004	0	2016	Counties:NY, WE, NA, RO,OR,SU		2	450	2			2							www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2	2			
H5991	006	0	1	01	01	H5991_006_0	5		1	08/03/2015	2016.01	08/03/2015 11:51:03 AM Eastern Daylight Time	07/31/2015 11:50:12 AM Eastern Daylight Time	07/31/2015 11:53:00 AM Eastern Daylight Time			08/03/2015 12:01:55 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Passport Essentials NYC (HMO)	01	01		1			H5991	006	0	2016	Affinity Medicare Passport Essentials NYC		2	1415	2			2							www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2	2			
H5992	007	0	1	01	01	H5992_007_0	5	2	1	08/03/2015	2016.01	08/03/2015 10:10:22 AM Eastern Daylight Time	08/04/2015 01:57:57 PM Eastern Daylight Time	08/04/2015 01:58:01 PM Eastern Daylight Time			08/04/2015 02:32:26 PM Eastern Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Senior Whole Health of New York	www.seniorwholehealth.com	Senior Whole Health of New York NHC (HMO SNP)	01	01		1			H5992	007	0	2016	Bronx, Kings, Queens, and New York counties		2	140	2			1	3		1	5			www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(877)353-0185		(646)273-2300		(877)353-0188		(646)273-2300		(877)353-0185		(646)273-2300		(877)353-0188		(646)273-2300		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5995	001	0	1	01	01	H5995_001_0	7	2	1	08/04/2015	2016.01	08/04/2015 02:46:50 PM Pacific Daylight Time	08/04/2015 04:26:14 PM Pacific Daylight Time	08/03/2015 09:47:36 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Special Needs Plan (Willamette) (HMO SNP)	01	01		1			H5995	001	0	2016	Marion and Polk Counties In Oregon		2	3364	2			1	3		1	3		2	www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					2	2			
H6059	001	0	1	20	08	H6059_001_0	2		1	05/27/2015	2016.01	05/27/2015 03:30:32 PM Eastern Daylight Time		05/27/2015 03:26:42 PM Eastern Daylight Time			05/27/2015 03:43:48 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	2016	PACE of The Triad - Dual		2		2			2								www.pacetriad.org	www.pacetriad.org									(336)550-4040		(336)550-4040		(336)550-4040		(336)550-4040										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6059	002	0	1	20	08	H6059_002_0	2		1	05/27/2015	2016.01	05/27/2015 03:31:43 PM Eastern Daylight Time		05/27/2015 03:26:56 PM Eastern Daylight Time			05/27/2015 03:43:48 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	2016	PACE of The Triad - Medicare only		2		2			2								www.pacetriad.org	www.pacetriad.org									(336)550-4040		(336)550-4040		(336)550-4040		(336)550-4040										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6079	001	0	1	20	08	H6079_001_0	1		1	05/26/2015	2016.01	05/26/2015 01:52:16 PM Mountain Daylight Time		05/18/2015 05:04:42 PM Mountain Daylight Time			05/26/2015 01:56:20 PM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge Greater California PACE	www.myinnovage.org	InnovAge Greater California PACE (PACE)	08	20		1			H6079	001	0	2016	San Bernardino and Riverside counties		2		2			2								www.totallongtermcare.org	www.pharmerica.com									(877)277-6163		(909)890-2800		(877)277-6163		(909)890-2800										(877)277-6163		(909)890-2800		(877)277-6163		(909)890-2800																
H6079	002	0	1	20	08	H6079_002_0	1		1	05/26/2015	2016.01	05/26/2015 01:52:32 PM Mountain Daylight Time		05/18/2015 05:06:01 PM Mountain Daylight Time			05/26/2015 01:56:20 PM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge Greater California PACE	www.myinnovage.org	InnovAge Greater California PACE (PACE)	08	20		1			H6079	002	0	2016	San Bernardino and Riverside counties		2		2			2								www.totallongtermcare.org	www.pharmerica.com									(877)277-6163		(909)890-2800		(877)277-6163		(909)890-2800										(877)277-6163		(909)890-2800		(877)277-6163		(909)890-2800																
H6080	001	0	1	48	05	H6080_001_0	6		1	08/24/2015	2016.01	08/24/2015 01:18:20 PM Eastern Daylight Time					08/24/2015 01:21:25 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Meridian Complete	www.MedicareMeridian.com	Meridian Complete (Medicare-Medicaid Plan)	05	48		1			H6080	001	0	2016	Cook, DuPage, Kane, and Will Counties		2		2			2							www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.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)-		2					2					2				
H6188	001	0	1	20	08	H6188_001_0	1		1	05/26/2015	2016.01	05/26/2015 05:15:08 PM Eastern Daylight Time		05/26/2015 09:37:25 AM Eastern Daylight Time			05/26/2015 05:17:07 PM Eastern Daylight Time	LUTHERAN SENIORLIFE VIECARE ARMSTRONG, LLC	LIFE Armstrong	www.lutheranseniorlife.org	VieCare Armstrong, LLC (PACE)	08	20		1			H6188	001	0	2016	LIFE Armstrong		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(724)776-1100		(724)776-1100		(724)776-1100		(724)776-1100										(724)776-1100		(724)776-1100		(724)776-1100		(724)776-1100																
H6188	002	0	1	20	08	H6188_002_0	1		1	05/26/2015	2016.01	05/26/2015 05:15:38 PM Eastern Daylight Time		05/26/2015 09:38:23 AM Eastern Daylight Time			05/26/2015 05:17:07 PM Eastern Daylight Time	LUTHERAN SENIORLIFE VIECARE ARMSTRONG, LLC	LIFE Armstrong	www.lutheranseniorlife.org	VieCare Armstrong, LLC (PACE)	08	20		1			H6188	002	0	2016	LIFE Armstrong		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(724)776-1100		(724)776-1100		(724)776-1100		(724)776-1100										(724)776-1100		(724)776-1100		(724)776-1100		(724)776-1100																
H6229	005	0	1	48	05	H6229_005_0	5		1	07/09/2015	2016.01	07/09/2015 04:54:55 PM Eastern Daylight Time					07/09/2015 05:21:08 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC.	Anthem Blue Cross Cal MediConnect	duals.caremore.com	CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)	05	48		1			H6229	005	0	2016	Los Angeles County (Partial)		2	6800	2			2							duals.caremore.com	duals.caremore.com	duals.caremore.com	(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H6229	006	0	1	48	05	H6229_006_0	5		1	08/13/2015	2016.01	08/13/2015 03:23:46 PM Eastern Daylight Time					08/13/2015 08:02:46 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC.	Anthem Blue Cross Cal MediConnect	mss.cammp.anthem.com	Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)	05	48		1			H6229	006	0	2016	Santa Clara County		2	4700	2			2							mss.cammp.anthem.com	mss.cammp.anthem.com	mss.cammp.anthem.com	(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H6231	001	0	1	20	08	H6231_001_0	2		1	05/21/2015	2016.01	05/21/2015 11:02:38 AM Central Daylight Time		05/20/2015 04:29:41 PM Central Daylight Time			05/21/2015 11:04:20 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.fmolhs.org	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	001	0	2016	PACE Baton Rouge		2		2			2								www.ololrmc.com	www.ololrmc.com									(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604										(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604																
H6231	002	0	1	20	08	H6231_002_0	2		1	05/21/2015	2016.01	05/21/2015 11:02:51 AM Central Daylight Time		05/20/2015 04:35:48 PM Central Daylight Time			05/21/2015 11:04:20 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.fmolhs.org	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	002	0	2016	PACE Baton Rouge		2		2			2								www.ololrmc.com	www.ololrmc.com									(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604										(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604																
H6237	003	1	1	01	01	H6237_003_1	7		1	08/05/2015	2016.01	08/05/2015 03:02:02 PM Mountain Daylight Time	08/05/2015 02:15:46 PM Mountain Daylight Time	08/05/2015 04:27:46 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H6237	003	1	2016	Portland Metro Area and Clark County, WA	Metro	2	2540	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6237	003	2	1	01	01	H6237_003_2	7		1	08/04/2015	2016.01	08/04/2015 10:34:46 AM Mountain Daylight Time	08/04/2015 03:11:48 PM Mountain Daylight Time	08/05/2015 04:28:06 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H6237	003	2	2016	Portland Metro Area and Clark County, WA	Non-Metro	2	1757	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6298	001	0	1	01	01	H6298_001_0	5		1	08/04/2015	2016.01	08/04/2015 03:46:08 PM Eastern Daylight Time	08/04/2015 02:50:20 PM Eastern Daylight Time	07/30/2015 04:48:30 PM Eastern Daylight Time			08/05/2015 11:29:50 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Value (HMO)	01	01		1			H6298	001	0	2016	Ohio		2	3374	2			2							healthspan.org/medicare	www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6298	002	0	1	01	01	H6298_002_0	6		1	08/04/2015	2016.01	08/04/2015 03:54:28 PM Eastern Daylight Time	08/04/2015 02:50:20 PM Eastern Daylight Time	07/30/2015 04:49:08 PM Eastern Daylight Time			08/05/2015 11:35:51 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Standard (HMO)	01	01		1			H6298	002	0	2016	Ohio		2	2126	2			2							healthspan.org/medicare	www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6298	005	0	1	01	01	H6298_005_0	3		1	06/22/2015	2016.01	06/22/2015 04:00:57 PM Eastern Daylight Time	05/28/2015 12:08:15 PM Eastern Daylight Time				06/22/2015 04:04:42 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Core 1 (HMO)	01	01		1			H6298	005	0	2016	Ohio		2	13	2			2							healthspan.org/medicare	www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6298	007	0	1	01	01	H6298_007_0	2		1	07/23/2015	2016.01	07/23/2015 09:54:57 AM Eastern Daylight Time	08/04/2015 02:50:20 PM Eastern Daylight Time	07/30/2015 04:50:30 PM Eastern Daylight Time			08/05/2015 11:39:34 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Core 2 (HMO)	01	01		1			H6298	007	0	2016	Ohio		2	92	2			2							healthspan.org/medicare	www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6298	009	0	1	01	01	H6298_009_0	6		1	08/04/2015	2016.01	08/04/2015 04:01:19 PM Eastern Daylight Time	08/04/2015 02:50:20 PM Eastern Daylight Time	07/30/2015 04:49:46 PM Eastern Daylight Time			08/05/2015 11:42:26 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Enhanced (HMO)	01	01		1			H6298	009	0	2016	Ohio		2	1340	2			2							healthspan.org/medicare	www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	002	0	1	01	01	H6306_002_0	7		1	07/14/2015	2016.01	07/14/2015 03:14:14 PM Pacific Daylight Time	07/31/2015 03:16:30 PM Pacific Daylight Time	07/31/2015 03:16:32 PM Pacific Daylight Time			07/31/2015 03:31:19 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstCarolinaCare Insurance Company	www.firstmedicare.com	FirstMedicare Direct HMO Plus (HMO)	01	01		1			H6306	002	0	2016	South Central North Carolina		2	3188	2			2							www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	003	0	1	01	01	H6306_003_0	8		1	07/31/2015	2016.01	07/31/2015 03:22:40 PM Pacific Daylight Time	07/31/2015 03:16:34 PM Pacific Daylight Time	07/31/2015 03:16:36 PM Pacific Daylight Time			07/31/2015 03:42:02 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstCarolinaCare Insurance Company	www.firstmedicare.com	FirstMedicare Direct HMO Standard (HMO)	01	01		1			H6306	003	0	2016	South Central North Carolina		2	1063	2			2							www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6308	001	0	1	48	05	H6308_001_0	10		1	08/26/2015	2016.01	08/26/2015 03:37:20 PM Eastern Daylight Time					08/26/2015 03:39:56 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York FIDA Plan	www.agewellnewyork.com	AgeWell New York FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H6308	001	0	2016	Ki, Qu, Brx, NY, Wes		2		2			2							www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(855)889-0046		(855)889-0046		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2				
H6310	001	0	1	20	08	H6310_001_0	1		1	06/01/2015	2016.01	06/01/2015 04:16:10 PM Eastern Daylight Time		05/29/2015 02:45:42 PM Eastern Daylight Time			06/01/2015 04:20:08 PM Eastern Daylight Time	INOVACARES	InovaCares for Seniors	www.Inova.org	InovaCares for Seniors Dual Eligible (PACE)	08	20		1			H6310	001	0	2016	Northern Virginia		2		2			2								www.inova.org	www.omnicare.com									(877)409-2811		(703)239-5888		(877)409-2811		(703)239-5888										(888)206-8041		(703)776-4815		(888)206-8041		(703)776-4815																
H6310	002	0	1	20	08	H6310_002_0	1		1	06/01/2015	2016.01	06/01/2015 04:17:16 PM Eastern Daylight Time		05/29/2015 02:47:13 PM Eastern Daylight Time			06/01/2015 04:20:08 PM Eastern Daylight Time	INOVACARES	InovaCares for Seniors	www.Inova.org	InovaCares for Seniors Medicare Only (PACE)	08	20		1			H6310	002	0	2016	Northern Virginia		2		2			2								www.inova.org	www.omnicare.com									(877)409-2811		(703)239-5888		(877)409-2811		(703)239-5888										(888)206-8041		(703)776-4815		(888)206-8041		(703)776-4815																
H6320	001	0	1	01	01	H6320_001_0	6		1	07/09/2015	2016.01	07/09/2015 01:08:33 PM Central Daylight Time		06/01/2015 07:50:39 PM Central Daylight Time		06/01/2015 07:48:44 PM Central Daylight Time	07/09/2015 01:48:51 PM Central Daylight Time	FRESENIUS HEALTH PLANS OF NORTH CAROLINA, INC.	Fresenius Health Plans	www.esrdplan.com	Fresenius Total Health (HMO SNP)	01	01		1			H6320	001	0	2016	Orange, Wake and Durham Counties		2	82	2			1	4		1		00000000100000000000		www.esrdplan.com	www.esrdplan.com	www.esrdplan.com	(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		2					2					2	2			
H6328	001	0	1	04	01	H6328_001_0	5		1	07/10/2015	2016.01	07/10/2015 12:03:17 PM Eastern Daylight Time	08/05/2015 12:29:07 PM Eastern Daylight Time	08/04/2015 02:36:33 PM Eastern Daylight Time			08/05/2015 07:02:35 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan I (PPO)	01	04		1			H6328	001	0	2016	Dallas/Fort Worth Metro Area		2	500	2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6328	002	0	1	04	01	H6328_002_0	7		1	07/10/2015	2016.01	07/10/2015 12:10:32 PM Eastern Daylight Time	08/05/2015 12:30:29 PM Eastern Daylight Time	08/04/2015 02:38:35 PM Eastern Daylight Time			08/05/2015 07:02:35 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan II (PPO)	01	04		1			H6328	002	0	2016	Dallas/Fort Worth Metro Area		2	500	2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6328	003	0	1	04	01	H6328_003_0	6		1	08/05/2015	2016.01	08/05/2015 05:10:29 PM Eastern Daylight Time	08/05/2015 05:07:12 PM Eastern Daylight Time	08/04/2015 02:50:42 PM Eastern Daylight Time			08/05/2015 07:02:35 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan III (PPO)	01	04		1			H6328	003	0	2016	Dallas/Fort Worth Metro Area		2	500	2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6328	005	0	1	04	01	H6328_005_0	5		1	07/10/2015	2016.01	07/10/2015 12:16:22 PM Eastern Daylight Time	07/09/2015 05:20:54 PM Eastern Daylight Time				07/17/2015 01:30:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan I MA-Only (PPO)	01	04		1			H6328	005	0	2016	Dallas/Fort Worth Metro Area		2	500	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	6		1	05/27/2015	2016.01	05/27/2015 12:25:12 PM Eastern Daylight Time	07/03/2015 01:47:09 AM Eastern Daylight Time				07/17/2015 01:30:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan Employer Group CY (PPO)	01	04		1			H6328	801	0	2016	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H6328	802	0	1	04	01	H6328_802_0	6		1	04/28/2015	2016.01	04/28/2015 03:50:03 PM Eastern Daylight Time	07/03/2015 01:49:35 AM Eastern Daylight Time				07/17/2015 01:30:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan Employer Group NCY (PPO)	01	04		1			H6328	802	0	2016	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H6328	803	0	1	04	01	H6328_803_0	7		1	05/27/2015	2016.01	05/27/2015 12:25:29 PM Eastern Daylight Time	07/03/2015 01:52:43 AM Eastern Daylight Time				07/17/2015 01:30:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan Employer Group CY (PPO)	01	04		1			H6328	803	0	2016	Nationwide		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)-										1	2		2		1						2			
H6328	804	0	1	04	01	H6328_804_0	7		1	04/28/2015	2016.01	04/28/2015 03:55:22 PM Eastern Daylight Time	07/03/2015 01:55:13 AM Eastern Daylight Time				07/17/2015 01:30:56 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan Employer Group NCY (PPO)	01	04		1			H6328	804	0	2016	Nationwide		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)-										1	2		2		1						2			
H6360	001	0	1	18	06	H6360_001_0	7		1	08/05/2015	2016.01	08/05/2015 10:42:33 AM Eastern Daylight Time		07/30/2015 04:51:17 PM Eastern Daylight Time			08/05/2015 11:45:28 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus I (Cost)	06	18		1			H6360	001	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	4013	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6360	002	0	1	18	06	H6360_002_0	6		1	08/05/2015	2016.01	08/05/2015 10:43:02 AM Eastern Daylight Time		07/30/2015 04:52:01 PM Eastern Daylight Time			08/05/2015 11:48:02 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus II (Cost)	06	18		1			H6360	002	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	2273	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6360	004	0	1	18	06	H6360_004_0	4		1	07/15/2015	2016.01	07/15/2015 05:20:58 PM Eastern Daylight Time					07/15/2015 05:24:35 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus Basic I (Cost)	06	18		1			H6360	004	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	397	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6360	006	0	1	18	06	H6360_006_0	5		1	07/15/2015	2016.01	07/15/2015 05:21:04 PM Eastern Daylight Time		07/30/2015 04:52:46 PM Eastern Daylight Time			08/05/2015 11:51:15 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus III (Cost)	06	18		1			H6360	006	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	376	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6360	007	0	1	18	06	H6360_007_0	4		1	07/15/2015	2016.01	07/15/2015 05:21:11 PM Eastern Daylight Time					07/15/2015 05:29:00 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus Basic II (Cost)	06	18		1			H6360	007	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	78	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6360	008	0	1	18	06	H6360_008_0	5		1	07/15/2015	2016.01	07/15/2015 05:21:19 PM Eastern Daylight Time					07/15/2015 05:30:47 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus Basic III (Cost)	06	18		1			H6360	008	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	117	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6360	009	0	2	18	06	H6360_009_0	5		1	08/05/2015	2016.01	08/05/2015 10:44:07 AM Eastern Daylight Time		07/30/2015 04:53:28 PM Eastern Daylight Time			08/05/2015 11:53:35 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus I - B only (Cost)	06	18		2	1		H6360	009	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	10	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6360	010	0	1	18	06	H6360_010_0	6		1	07/15/2015	2016.01	07/15/2015 05:21:33 PM Eastern Daylight Time		07/30/2015 04:54:08 PM Eastern Daylight Time			08/05/2015 12:24:08 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus IV (Cost)	06	18		1			H6360	010	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	769	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6360	011	0	1	18	06	H6360_011_0	5		1	07/15/2015	2016.01	07/15/2015 05:21:40 PM Eastern Daylight Time					07/15/2015 05:37:12 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus Basic IV (Cost)	06	18		1			H6360	011	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	38	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6360	012	0	1	18	06	H6360_012_0	5		1	07/16/2015	2016.01	07/16/2015 05:05:29 PM Eastern Daylight Time					07/16/2015 05:06:48 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Only Basic (Cost)	06	18		1			H6360	012	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	2	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6360	013	0	2	18	06	H6360_013_0	5		1	07/16/2015	2016.01	07/16/2015 05:10:24 PM Eastern Daylight Time					07/16/2015 05:11:17 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Only Basic - B Only (Cost)	06	18		2	1		H6360	013	0	2016	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	0	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)349-8882		(216)621-7100										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6360	801	0	1	18	06	H6360_801_0	2		1	05/28/2015	2016.01	05/28/2015 09:52:16 AM Eastern Daylight Time					05/29/2015 04:33:43 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus Group (Cost)	06	18		1			H6360	801	0	2016	Ohio		1	2477	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-													2			
H6360	805	0	2	18	06	H6360_805_0	2		1	05/28/2015	2016.01	05/28/2015 09:52:22 AM Eastern Daylight Time					05/29/2015 04:35:54 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	HealthSpan Medicare Plus Group - B only (Cost)	06	18		2	1		H6360	805	0	2016	Ohio		1	283	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-													2			
H6360	806	0	1	18	06	H6360_806_0	2		1	05/28/2015	2016.01	05/28/2015 09:52:28 AM Eastern Daylight Time					05/29/2015 04:37:27 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	FEHB AB with D (Cost)	06	18		1			H6360	806	0	2016	Ohio		1	515	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-													2			
H6360	807	0	2	18	06	H6360_807_0	2		1	05/28/2015	2016.01	05/28/2015 09:52:34 AM Eastern Daylight Time					05/29/2015 04:39:06 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	www.healthspan.org/medicare	FEHB B only with D (Cost)	06	18		2	1		H6360	807	0	2016	Ohio		1	5	2			2								www.healthspan.org/seniormedrx	www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(800)493-6004		(216)621-7100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-													2			
H6361	001	0	1	01	01	H6361_001_0	6		1	08/03/2015	2016.01	08/03/2015 01:45:05 PM Central Daylight Time	08/03/2015 12:05:03 PM Central Daylight Time	07/31/2015 03:28:40 PM Central Daylight Time			08/04/2015 04:54:50 PM Central Daylight Time	TODAY'S OPTIONS OF NEW YORK, INC.	Today's Options of New York, Inc.	http://www.universal-american-medicare.com/	Today's Options Classic (HMO)	01	01		1			H6361	001	0	2016	Select counties in NY		2		2			2							http://www.universal-american-medicare.com/	www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6371	001	0	1	20	08	H6371_001_0	1		1	05/19/2015	2016.01	05/19/2015 03:30:58 PM Eastern Daylight Time		05/18/2015 05:54:00 PM Eastern Daylight Time			05/19/2015 03:34:14 PM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	001	0	2016	Lutheran Senior LIFE Hudson County		2		2			2								www.lifelsmnj.org	www.lifelsmnj.org									(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091										(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091																
H6371	002	0	1	20	08	H6371_002_0	1		1	05/19/2015	2016.01	05/19/2015 03:31:57 PM Eastern Daylight Time		05/18/2015 06:05:43 PM Eastern Daylight Time			05/19/2015 03:34:14 PM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	002	0	2016	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																
H6435	001	0	1	48	05	H6435_001_0	9		1	08/25/2015	2016.01	08/25/2015 03:23:59 PM Eastern Daylight Time					08/25/2015 03:28:08 PM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	RiverSpring FIDA Medicare-Medicaid Plan	www.riverspringFIDA.org	RiverSpring FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H6435	001	0	2016	Brx, Ki, Na, NY, Qu, Ri, Suf, Wes		2	300	2			2							www.riverspringFIDA.org	www.riverspringFIDA.org	www.riverspringFIDA.org	(800)950-9000		(800)950-9000		(800)950-9000		(800)950-9000		(855)898-1482		(313)324-3800		(855)898-1482		(313)324-3800		(711)-		(711)-		(711)-		(711)-		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2				
H6453	001	0	1	01	01	H6453_001_0	5		1	08/03/2015	2016.01	08/03/2015 04:19:55 PM Central Daylight Time	08/03/2015 04:56:05 PM Central Daylight Time	08/03/2015 04:56:41 PM Central Daylight Time			08/03/2015 06:57:40 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	001	0	2016	Baton Rouge		2	1743	2			2							www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	002	0	1	01	01	H6453_002_0	5		1	08/03/2015	2016.01	08/03/2015 04:20:13 PM Central Daylight Time	08/03/2015 04:57:17 PM Central Daylight Time	08/03/2015 04:57:49 PM Central Daylight Time			08/03/2015 06:57:40 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	002	0	2016	Greater New Orleans		2	2749	2			2							www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	003	0	1	01	01	H6453_003_0	5		1	08/03/2015	2016.01	08/03/2015 04:20:32 PM Central Daylight Time	08/03/2015 04:58:25 PM Central Daylight Time	08/03/2015 04:59:00 PM Central Daylight Time			08/03/2015 06:57:40 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	003	0	2016	North Shore		2	932	2			2							www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	004	0	1	01	01	H6453_004_0	5		1	08/03/2015	2016.01	08/03/2015 04:20:52 PM Central Daylight Time	08/03/2015 04:59:47 PM Central Daylight Time	08/03/2015 04:55:28 PM Central Daylight Time			08/03/2015 06:57:40 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	004	0	2016	Acadiana		2	474	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	3		1	05/28/2015	2016.01	05/28/2015 10:45:06 AM Central Daylight Time	05/29/2015 08:43:34 PM Central Daylight Time				05/29/2015 08:46:08 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	801	0	2016	Parts of Southeast Louisiana		1	33	2			2							www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1	2			
H6453	802	0	1	01	01	H6453_802_0	4		1	05/28/2015	2016.01	05/28/2015 10:38:41 AM Central Daylight Time	05/29/2015 08:44:15 PM Central Daylight Time				05/29/2015 08:46:08 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	802	0	2016	Parts of Southeast Louisiana		1	599	2			2							www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1	2			
H6453	803	0	1	01	01	H6453_803_0	3		1	05/26/2015	2016.01	05/26/2015 04:21:07 PM Central Daylight Time	05/29/2015 08:42:53 PM Central Daylight Time				05/29/2015 08:46:08 PM Central Daylight Time	HMO LOUISIANA, INC.	Blue Cross Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	01	01		1			H6453	803	0	2016	Parts of Southeast Louisiana		1	33	2			2							www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1	2			
H6528	006	0	1	04	01	H6528_006_0	2		1	07/31/2015	2016.01	07/31/2015 12:42:22 PM Central Daylight Time	07/31/2015 01:00:20 PM Central Daylight Time	07/30/2015 10:40:39 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (PPO)	01	04		1			H6528	006	0	2016	Various Counties in AR, GA, MO, and SC		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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	016	0	1	04	01	H6528_016_0	2		1	07/31/2015	2016.01	07/31/2015 12:44:11 PM Central Daylight Time	07/31/2015 01:00:45 PM Central Daylight Time	07/30/2015 10:40:56 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (PPO SNP)	01	04		1			H6528	016	0	2016	Various Counties in AR, GA, MO, and SC		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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	029	0	1	04	01	H6528_029_0	2		1	07/31/2015	2016.01	07/31/2015 12:47:53 PM Central Daylight Time	07/31/2015 01:01:10 PM Central Daylight Time	07/30/2015 10:41:13 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (PPO SNP)	01	04		1			H6528	029	0	2016	Various Counties in Illinois, Indiana		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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	030	0	1	04	01	H6528_030_0	2		1	07/31/2015	2016.01	07/31/2015 12:55:22 PM Central Daylight Time	07/31/2015 01:01:35 PM Central Daylight Time	07/30/2015 10:41:28 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (PPO)	01	04		1			H6528	030	0	2016	Various Counties in Illinois, Indiana		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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			
H6551	001	0	1	20	08	H6551_001_0	1		1	05/26/2015	2016.01	05/26/2015 09:39:22 AM Eastern Daylight Time		05/21/2015 08:52:46 AM Eastern Daylight Time			05/26/2015 09:45:41 AM Eastern Daylight Time	LIFE ST. MARY, INC.	LIFE St. Mary	http://www.lifestmary.org/	LIFE St. Mary (PACE)	08	20		1			H6551	001	0	2016	LIFE St. Mary		2		2			2								stmaryhealthcare.org	stmaryhealthcare.org									(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601										(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601																
H6551	002	0	1	20	08	H6551_002_0	1		1	05/26/2015	2016.01	05/26/2015 09:39:57 AM Eastern Daylight Time		05/21/2015 08:54:27 AM Eastern Daylight Time			05/26/2015 09:45:41 AM Eastern Daylight Time	LIFE ST. MARY, INC.	LIFE St. Mary	www.lifestmary.org	LIFE St. Mary (PACE)	08	20		1			H6551	002	0	2016	LIFE St. Mary		2		2			2								stmaryhealthcare.org	stmaryhealthcare.org									(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601										(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601																
H6609	001	0	1	04	01	H6609_001_0	4		1	07/08/2015	2016.01	07/08/2015 12:56:18 PM Eastern Daylight Time	08/04/2015 10:14:59 AM Eastern Daylight Time	07/29/2015 11:49:10 PM Eastern Daylight Time			08/04/2015 01:11:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-001 (PPO)	01	04		1			H6609	001	0	2016	Select Counties in South Dakota		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	003	0	1	04	01	H6609_003_0	3		1	07/07/2015	2016.01	07/07/2015 03:09:39 PM Eastern Daylight Time	08/04/2015 09:59:46 AM Eastern Daylight Time	07/29/2015 11:49:46 PM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-003 (PPO)	01	04		1			H6609	003	0	2016	Omaha Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	004	0	1	04	01	H6609_004_0	3		1	07/20/2015	2016.01	07/20/2015 03:59:08 PM Eastern Daylight Time	07/20/2015 12:20:23 PM Eastern Daylight Time				07/22/2015 01:52:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-004 (PPO)	01	04		1			H6609	004	0	2016	Select Counties in IA, NE, ND and SD		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6609	009	0	1	04	01	H6609_009_0	3		1	07/09/2015	2016.01	07/09/2015 03:51:07 PM Eastern Daylight Time	08/03/2015 11:16:41 AM Eastern Daylight Time	07/29/2015 11:50:22 PM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-009 (PPO)	01	04		1			H6609	009	0	2016	Select Counties in Idaho and Oregon		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	012	0	1	04	01	H6609_012_0	2		1	07/09/2015	2016.01	07/09/2015 03:57:49 PM Eastern Daylight Time	05/24/2015 02:17:46 PM Eastern Daylight Time				07/10/2015 01:58:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-012 (PPO)	01	04		1			H6609	012	0	2016	Select Counties in ID, OR, WA and UT		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H6609	013	0	1	04	01	H6609_013_0	3		1	07/07/2015	2016.01	07/07/2015 03:59:54 PM Eastern Daylight Time	08/03/2015 11:21:14 AM Eastern Daylight Time	07/29/2015 11:50:56 PM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-013 (PPO)	01	04		1			H6609	013	0	2016	Select Counties in Washington and Oregon		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	017	0	1	04	01	H6609_017_0	3		1	07/07/2015	2016.01	07/07/2015 03:22:10 PM Eastern Daylight Time	08/04/2015 10:33:03 AM Eastern Daylight Time	07/29/2015 11:51:32 PM Eastern Daylight Time			08/04/2015 01:11:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-017 (PPO)	01	04		1			H6609	017	0	2016	Select Counties in North Dakota		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	019	0	1	04	01	H6609_019_0	3		1	07/07/2015	2016.01	07/07/2015 03:22:54 PM Eastern Daylight Time	08/04/2015 10:37:41 AM Eastern Daylight Time	07/29/2015 11:52:08 PM Eastern Daylight Time			08/04/2015 01:11:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-019 (PPO)	01	04		1			H6609	019	0	2016	Select Counties in South Dakota		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	029	0	1	04	01	H6609_029_0	3		1	07/07/2015	2016.01	07/07/2015 03:23:40 PM Eastern Daylight Time	08/04/2015 11:04:33 AM Eastern Daylight Time	07/29/2015 11:52:44 PM Eastern Daylight Time			08/04/2015 01:11:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-029 (PPO)	01	04		1			H6609	029	0	2016	Cascade, Flathead and Ravalli counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	073	0	1	04	01	H6609_073_0	3		1	07/07/2015	2016.01	07/07/2015 04:01:09 PM Eastern Daylight Time	08/03/2015 11:23:48 AM Eastern Daylight Time	07/29/2015 11:53:20 PM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-073 (PPO)	01	04		1			H6609	073	0	2016	Select Counties in ID, OR and WA		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	075	0	1	04	01	H6609_075_0	3		1	07/07/2015	2016.01	07/07/2015 03:24:07 PM Eastern Daylight Time	08/04/2015 10:53:44 AM Eastern Daylight Time	07/29/2015 11:53:56 PM Eastern Daylight Time			08/04/2015 01:11:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-075 (PPO)	01	04		1			H6609	075	0	2016	Carbon, Stillwater and Yellowstone counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	077	0	1	04	01	H6609_077_0	3		1	07/08/2015	2016.01	07/08/2015 04:15:35 PM Eastern Daylight Time	07/31/2015 05:17:00 PM Eastern Daylight Time	07/29/2015 11:54:30 PM Eastern Daylight Time			08/04/2015 02:20:15 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-077 (PPO)	01	04		1			H6609	077	0	2016	Select Counties in Indiana and Kentucky		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	078	0	1	04	01	H6609_078_0	4		1	07/08/2015	2016.01	07/08/2015 08:18:18 AM Eastern Daylight Time	07/31/2015 05:17:20 PM Eastern Daylight Time	07/29/2015 11:55:06 PM Eastern Daylight Time			08/04/2015 02:20:15 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-078 (PPO)	01	04		1			H6609	078	0	2016	Lexington Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	080	0	1	04	01	H6609_080_0	4		1	07/08/2015	2016.01	07/08/2015 08:18:43 AM Eastern Daylight Time	07/31/2015 05:13:55 PM Eastern Daylight Time	07/29/2015 11:55:42 PM Eastern Daylight Time			08/04/2015 02:20:15 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-080 (PPO)	01	04		1			H6609	080	0	2016	Barren, Metcalfe and Warren counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	081	0	1	04	01	H6609_081_0	4		1	07/08/2015	2016.01	07/08/2015 08:19:05 AM Eastern Daylight Time	07/31/2015 05:41:26 PM Eastern Daylight Time	07/29/2015 11:56:16 PM Eastern Daylight Time			08/04/2015 02:20:15 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-081 (PPO)	01	04		1			H6609	081	0	2016	Cincinnati and Dayton Areas		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	082	0	1	04	01	H6609_082_0	4		1	07/08/2015	2016.01	07/08/2015 08:19:41 AM Eastern Daylight Time	07/31/2015 06:03:49 PM Eastern Daylight Time	07/29/2015 11:56:52 PM Eastern Daylight Time			08/04/2015 02:20:15 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-082 (PPO)	01	04		1			H6609	082	0	2016	Cleveland Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	083	0	1	04	01	H6609_083_0	4		1	07/08/2015	2016.01	07/08/2015 08:20:01 AM Eastern Daylight Time	07/31/2015 05:43:16 PM Eastern Daylight Time	07/29/2015 11:57:28 PM Eastern Daylight Time			08/04/2015 02:20:15 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-083 (PPO)	01	04		1			H6609	083	0	2016	Columbus Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	084	0	1	04	01	H6609_084_0	3		1	07/09/2015	2016.01	07/09/2015 03:50:30 PM Eastern Daylight Time	07/31/2015 05:45:14 PM Eastern Daylight Time	07/29/2015 11:58:02 PM Eastern Daylight Time			08/04/2015 02:20:15 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-084 (PPO)	01	04		1			H6609	084	0	2016	Northwest Ohio Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	085	0	1	04	01	H6609_085_0	4		1	07/08/2015	2016.01	07/08/2015 08:21:21 AM Eastern Daylight Time	07/31/2015 05:44:34 PM Eastern Daylight Time	07/29/2015 11:58:38 PM Eastern Daylight Time			08/04/2015 02:24:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-085 (PPO)	01	04		1			H6609	085	0	2016	Canton Metropolitan Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	086	0	1	04	01	H6609_086_0	4		1	07/08/2015	2016.01	07/08/2015 08:21:51 AM Eastern Daylight Time	07/31/2015 05:56:45 PM Eastern Daylight Time	07/29/2015 11:59:14 PM Eastern Daylight Time			08/04/2015 02:24:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-086 (PPO)	01	04		1			H6609	086	0	2016	Ohio Valley Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	088	0	1	04	01	H6609_088_0	3		1	07/08/2015	2016.01	07/08/2015 08:18:15 AM Eastern Daylight Time	08/01/2015 10:01:59 AM Eastern Daylight Time	07/29/2015 11:59:50 PM Eastern Daylight Time			08/04/2015 01:06:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-088 (PPO)	01	04		1			H6609	088	0	2016	Memphis Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	089	0	1	04	01	H6609_089_0	3		1	07/08/2015	2016.01	07/08/2015 08:18:38 AM Eastern Daylight Time	08/01/2015 10:03:19 AM Eastern Daylight Time	07/30/2015 12:00:26 AM Eastern Daylight Time			08/04/2015 01:06:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-089 (PPO)	01	04		1			H6609	089	0	2016	Nashville Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	090	0	1	04	01	H6609_090_0	3		1	07/08/2015	2016.01	07/08/2015 08:19:04 AM Eastern Daylight Time	08/01/2015 10:02:58 AM Eastern Daylight Time	07/30/2015 12:01:00 AM Eastern Daylight Time			08/04/2015 01:06:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-090 (PPO)	01	04		1			H6609	090	0	2016	Chattanooga Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	091	0	1	04	01	H6609_091_0	3		1	07/08/2015	2016.01	07/08/2015 08:19:28 AM Eastern Daylight Time	08/01/2015 09:54:31 AM Eastern Daylight Time	07/30/2015 12:01:36 AM Eastern Daylight Time			08/04/2015 01:06:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-091 (PPO)	01	04		1			H6609	091	0	2016	Knoxville Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	092	0	1	04	01	H6609_092_0	3		1	07/08/2015	2016.01	07/08/2015 08:20:45 AM Eastern Daylight Time	08/01/2015 09:57:13 AM Eastern Daylight Time	07/30/2015 12:02:12 AM Eastern Daylight Time			08/04/2015 01:06:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-092 (PPO)	01	04		1			H6609	092	0	2016	Select Counties in the Tri-Cities Area of Virginia		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	095	0	1	04	01	H6609_095_0	3		1	07/09/2015	2016.01	07/09/2015 03:42:02 PM Eastern Daylight Time	07/31/2015 06:07:45 PM Eastern Daylight Time	07/30/2015 12:02:48 AM Eastern Daylight Time			08/04/2015 01:52:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-095 (PPO)	01	04		1			H6609	095	0	2016	Northeast Virginia area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	096	0	1	04	01	H6609_096_0	3		1	07/08/2015	2016.01	07/08/2015 08:49:32 AM Eastern Daylight Time	07/31/2015 06:07:13 PM Eastern Daylight Time	07/30/2015 12:03:24 AM Eastern Daylight Time			08/04/2015 01:52:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-096 (PPO)	01	04		1			H6609	096	0	2016	Northern Virginia area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	097	0	1	04	01	H6609_097_0	4		1	07/20/2015	2016.01	07/20/2015 04:54:48 PM Eastern Daylight Time	08/01/2015 09:54:51 AM Eastern Daylight Time	07/30/2015 12:03:58 AM Eastern Daylight Time			08/04/2015 01:06:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-097 (PPO)	01	04		1			H6609	097	0	2016	Huntsville Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	098	0	1	04	01	H6609_098_0	3		1	07/08/2015	2016.01	07/08/2015 08:49:44 AM Eastern Daylight Time	07/31/2015 06:11:29 PM Eastern Daylight Time	07/30/2015 12:04:34 AM Eastern Daylight Time			08/04/2015 01:52:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-098 (PPO)	01	04		1			H6609	098	0	2016	Richmond Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	099	0	1	04	01	H6609_099_0	3		1	07/08/2015	2016.01	07/08/2015 11:24:53 AM Eastern Daylight Time	08/01/2015 09:54:10 AM Eastern Daylight Time	07/30/2015 12:05:10 AM Eastern Daylight Time			08/04/2015 01:06:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-099 (PPO)	01	04		1			H6609	099	0	2016	Birmingham Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	100	0	1	04	01	H6609_100_0	3		1	07/08/2015	2016.01	07/08/2015 08:50:00 AM Eastern Daylight Time	07/31/2015 06:00:25 PM Eastern Daylight Time	07/30/2015 12:05:46 AM Eastern Daylight Time			08/04/2015 01:52:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-100 (PPO)	01	04		1			H6609	100	0	2016	Roanoke Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	102	0	1	04	01	H6609_102_0	3		1	07/08/2015	2016.01	07/08/2015 08:50:15 AM Eastern Daylight Time	07/31/2015 06:10:25 PM Eastern Daylight Time	07/30/2015 12:06:20 AM Eastern Daylight Time			08/04/2015 01:52:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-102 (PPO)	01	04		1			H6609	102	0	2016	Kent and New Castle counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	103	0	1	04	01	H6609_103_0	3		1	07/09/2015	2016.01	07/09/2015 03:42:41 PM Eastern Daylight Time	07/31/2015 06:10:58 PM Eastern Daylight Time	07/30/2015 12:06:56 AM Eastern Daylight Time			08/04/2015 01:52:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-103 (PPO)	01	04		1			H6609	103	0	2016	Allegany, Garrett and Washington counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	104	0	1	04	01	H6609_104_0	3		1	07/08/2015	2016.01	07/08/2015 08:27:40 AM Eastern Daylight Time	08/03/2015 02:02:07 PM Eastern Daylight Time	07/30/2015 12:07:32 AM Eastern Daylight Time			08/04/2015 12:49:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-104 (PPO)	01	04		1			H6609	104	0	2016	Select Louisiana Parishes		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	105	0	1	04	01	H6609_105_0	3		1	07/08/2015	2016.01	07/08/2015 08:28:01 AM Eastern Daylight Time	08/03/2015 01:53:37 PM Eastern Daylight Time	07/30/2015 12:08:08 AM Eastern Daylight Time			08/04/2015 12:49:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-105 (PPO)	01	04		1			H6609	105	0	2016	Gulf Coast / Biloxi Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	106	0	1	04	01	H6609_106_0	3		1	07/08/2015	2016.01	07/08/2015 08:28:28 AM Eastern Daylight Time	08/03/2015 01:52:14 PM Eastern Daylight Time	07/30/2015 12:08:42 AM Eastern Daylight Time			08/04/2015 12:49:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-106 (PPO)	01	04		1			H6609	106	0	2016	Select Counties in Mississippi		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	107	0	1	04	01	H6609_107_0	3		1	07/08/2015	2016.01	07/08/2015 08:28:46 AM Eastern Daylight Time	08/03/2015 01:57:38 PM Eastern Daylight Time	07/30/2015 12:09:18 AM Eastern Daylight Time			08/04/2015 12:49:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-107 (PPO)	01	04		1			H6609	107	0	2016	Grenada, Lafayette and Yalobusha Counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	108	0	1	04	01	H6609_108_0	3		1	07/08/2015	2016.01	07/08/2015 08:20:52 AM Eastern Daylight Time	07/31/2015 04:49:52 PM Eastern Daylight Time	07/30/2015 12:09:54 AM Eastern Daylight Time			08/04/2015 03:22:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-108 (PPO)	01	04		1			H6609	108	0	2016	Select Counties in Texas		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	110	0	1	04	01	H6609_110_0	3		1	07/08/2015	2016.01	07/08/2015 08:21:19 AM Eastern Daylight Time	08/03/2015 04:14:19 PM Eastern Daylight Time	07/30/2015 12:10:28 AM Eastern Daylight Time			08/04/2015 03:15:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-110 (PPO)	01	04		1			H6609	110	0	2016	Colorado's I-25 Corridor/Grand Junction Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;8a1;8a2;8b3;	
H6609	111	0	1	04	01	H6609_111_0	2		1	07/08/2015	2016.01	07/08/2015 08:21:43 AM Eastern Daylight Time	05/28/2015 07:57:27 AM Eastern Daylight Time				07/10/2015 02:27:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-111 (PPO)	01	04		1			H6609	111	0	2016	Select Counties in Colorado and New Mexico		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						1	01	4b;8a1;8a2;8b3;	
H6609	112	0	1	04	01	H6609_112_0	3		1	07/08/2015	2016.01	07/08/2015 08:22:10 AM Eastern Daylight Time	08/03/2015 04:15:52 PM Eastern Daylight Time	07/30/2015 12:11:04 AM Eastern Daylight Time			08/04/2015 03:15:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-112 (PPO)	01	04		1			H6609	112	0	2016	Colorado's I-25 Corridor/Grand Junction Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;8a1;8a2;8b3;	
H6609	113	0	1	04	01	H6609_113_0	3		1	07/08/2015	2016.01	07/08/2015 08:22:41 AM Eastern Daylight Time	08/03/2015 04:17:04 PM Eastern Daylight Time	07/30/2015 12:11:40 AM Eastern Daylight Time			08/04/2015 03:15:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-113 (PPO)	01	04		1			H6609	113	0	2016	Colorado's I-25 Corridor/Grand Junction Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;8a1;8a2;8b3;	
H6609	115	0	1	04	01	H6609_115_0	3		1	07/08/2015	2016.01	07/08/2015 08:23:18 AM Eastern Daylight Time	08/03/2015 04:16:35 PM Eastern Daylight Time	07/30/2015 12:12:14 AM Eastern Daylight Time			08/04/2015 03:15:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-115 (PPO)	01	04		1			H6609	115	0	2016	Select Counties in New Mexico		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	01	4b;8a1;8a2;8b3;	
H6609	116	0	1	04	01	H6609_116_0	3		1	07/08/2015	2016.01	07/08/2015 04:19:04 PM Eastern Daylight Time	07/31/2015 05:13:15 PM Eastern Daylight Time	07/30/2015 12:12:50 AM Eastern Daylight Time			08/04/2015 02:24:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-116 (PPO)	01	04		1			H6609	116	0	2016	Charleston-Huntington Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	117	0	1	04	01	H6609_117_0	4		1	07/08/2015	2016.01	07/08/2015 08:22:32 AM Eastern Daylight Time	07/31/2015 05:14:15 PM Eastern Daylight Time	07/30/2015 12:13:26 AM Eastern Daylight Time			08/04/2015 02:24:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-117 (PPO)	01	04		1			H6609	117	0	2016	Martinsburg Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	118	0	1	04	01	H6609_118_0	3		1	07/08/2015	2016.01	07/08/2015 08:22:04 AM Eastern Daylight Time	08/01/2015 09:56:31 AM Eastern Daylight Time	07/30/2015 12:14:00 AM Eastern Daylight Time			08/04/2015 01:19:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-118 (PPO)	01	04		1			H6609	118	0	2016	Montgomery Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	119	0	1	04	01	H6609_119_0	3		1	07/08/2015	2016.01	07/08/2015 08:22:36 AM Eastern Daylight Time	08/01/2015 09:56:10 AM Eastern Daylight Time	07/30/2015 12:14:36 AM Eastern Daylight Time			08/04/2015 01:19:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-119 (PPO)	01	04		1			H6609	119	0	2016	Dothan Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	120	0	1	04	01	H6609_120_0	3		1	07/09/2015	2016.01	07/09/2015 03:40:28 PM Eastern Daylight Time	07/31/2015 04:04:11 PM Eastern Daylight Time	07/30/2015 12:15:12 AM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-120 (PPO)	01	04		1			H6609	120	0	2016	Greater Georgia		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	121	0	1	04	01	H6609_121_0	3		1	07/08/2015	2016.01	07/08/2015 08:15:29 AM Eastern Daylight Time	08/03/2015 11:03:28 AM Eastern Daylight Time	07/30/2015 12:15:48 AM Eastern Daylight Time			08/04/2015 12:55:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-121 (PPO)	01	04		1			H6609	121	0	2016	Select Counties in Oklahoma		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	122	0	1	04	01	H6609_122_0	3		1	07/08/2015	2016.01	07/08/2015 08:19:07 AM Eastern Daylight Time	07/31/2015 04:06:26 PM Eastern Daylight Time	07/30/2015 12:16:22 AM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-122 (PPO)	01	04		1			H6609	122	0	2016	Atlanta Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	123	0	1	04	01	H6609_123_0	3		1	07/08/2015	2016.01	07/08/2015 08:24:31 AM Eastern Daylight Time	08/03/2015 10:50:26 AM Eastern Daylight Time	07/30/2015 12:16:58 AM Eastern Daylight Time			08/04/2015 12:55:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-123 (PPO)	01	04		1			H6609	123	0	2016	Select Counties in AR, KS and MO		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	124	0	1	04	01	H6609_124_0	3		1	07/08/2015	2016.01	07/08/2015 08:19:54 AM Eastern Daylight Time	07/31/2015 03:58:57 PM Eastern Daylight Time	07/30/2015 12:17:34 AM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-124 (PPO)	01	04		1			H6609	124	0	2016	Charleston Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	125	0	1	04	01	H6609_125_0	3		1	07/08/2015	2016.01	07/08/2015 08:20:31 AM Eastern Daylight Time	07/31/2015 04:32:02 PM Eastern Daylight Time	07/30/2015 12:18:08 AM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-125 (PPO)	01	04		1			H6609	125	0	2016	Greater North Carolina Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	126	0	1	04	01	H6609_126_0	3		1	07/08/2015	2016.01	07/08/2015 08:32:07 AM Eastern Daylight Time	08/03/2015 11:04:41 AM Eastern Daylight Time	07/30/2015 12:18:44 AM Eastern Daylight Time			08/04/2015 12:55:17 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-126 (PPO)	01	04		1			H6609	126	0	2016	Select Counties in AR, KS, MO and OK		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	127	0	1	04	01	H6609_127_0	3		1	07/09/2015	2016.01	07/09/2015 03:41:52 PM Eastern Daylight Time	07/31/2015 03:59:26 PM Eastern Daylight Time	07/30/2015 12:19:20 AM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-127 (PPO)	01	04		1			H6609	127	0	2016	Spartanburg/Greenville Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	128	0	1	04	01	H6609_128_0	3		1	07/09/2015	2016.01	07/09/2015 04:03:14 PM Eastern Daylight Time	08/03/2015 11:27:36 AM Eastern Daylight Time	07/30/2015 12:19:56 AM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-128 (PPO)	01	04		1			H6609	128	0	2016	Select Counties in Utah		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	129	0	1	04	01	H6609_129_0	3		1	07/07/2015	2016.01	07/07/2015 04:21:54 PM Eastern Daylight Time	07/31/2015 03:58:15 PM Eastern Daylight Time	07/30/2015 12:20:32 AM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-129 (PPO)	01	04		1			H6609	129	0	2016	Clark County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	130	0	1	04	01	H6609_130_0	3		1	07/07/2015	2016.01	07/07/2015 04:22:37 PM Eastern Daylight Time	07/31/2015 04:09:26 PM Eastern Daylight Time	07/30/2015 12:21:06 AM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-130 (PPO)	01	04		1			H6609	130	0	2016	Clark County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	131	0	1	04	01	H6609_131_0	3		1	07/07/2015	2016.01	07/07/2015 04:22:59 PM Eastern Daylight Time	07/31/2015 04:00:11 PM Eastern Daylight Time	07/30/2015 12:21:42 AM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-131 (PPO)	01	04		1			H6609	131	0	2016	Washoe County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	132	0	1	04	01	H6609_132_0	3		1	07/07/2015	2016.01	07/07/2015 04:23:26 PM Eastern Daylight Time	07/31/2015 04:05:30 PM Eastern Daylight Time	07/30/2015 12:22:18 AM Eastern Daylight Time			08/04/2015 01:35:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-132 (PPO)	01	04		1			H6609	132	0	2016	Washoe County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	133	0	1	04	01	H6609_133_0	3		1	07/07/2015	2016.01	07/07/2015 03:49:24 PM Eastern Daylight Time	07/31/2015 04:07:42 PM Eastern Daylight Time	07/30/2015 12:16:52 PM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-133 (PPO)	01	04		1			H6609	133	0	2016	Maricopa, Pima, Pinal and Santa Cruz counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	135	0	1	04	01	H6609_135_0	3		1	07/07/2015	2016.01	07/07/2015 03:49:46 PM Eastern Daylight Time	07/31/2015 04:02:32 PM Eastern Daylight Time	07/30/2015 12:23:28 AM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-135 (PPO)	01	04		1			H6609	135	0	2016	La Paz, Mohave and Yavapai counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	137	0	1	04	01	H6609_137_0	3		1	07/07/2015	2016.01	07/07/2015 03:50:06 PM Eastern Daylight Time	08/03/2015 05:21:30 PM Eastern Daylight Time	07/30/2015 12:17:28 PM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-137 (PPO)	01	04		1			H6609	137	0	2016	Honolulu, Kauai and Maui counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	138	0	1	04	01	H6609_138_0	3		1	07/07/2015	2016.01	07/07/2015 03:10:44 PM Eastern Daylight Time	08/04/2015 11:18:31 AM Eastern Daylight Time	07/30/2015 12:24:40 AM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-138 (PPO)	01	04		1			H6609	138	0	2016	Select Counties in Iowa		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	140	0	1	04	01	H6609_140_0	3		1	07/07/2015	2016.01	07/07/2015 03:11:14 PM Eastern Daylight Time	08/04/2015 11:29:28 AM Eastern Daylight Time	07/30/2015 12:25:16 AM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-140 (PPO)	01	04		1			H6609	140	0	2016	Select Counties in Iowa		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	142	1	1	04	01	H6609_142_1	3		1	07/07/2015	2016.01	07/07/2015 03:11:35 PM Eastern Daylight Time	08/04/2015 11:53:49 AM Eastern Daylight Time	07/30/2015 12:25:50 AM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-142 (PPO)	01	04		1			H6609	142	1	2016	Select Counties in Minnesota	Tri-Cities area	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	142	2	1	04	01	H6609_142_2	3		1	07/07/2015	2016.01	07/07/2015 03:12:07 PM Eastern Daylight Time	08/04/2015 12:00:52 PM Eastern Daylight Time	07/30/2015 12:26:26 AM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-142 (PPO)	01	04		1			H6609	142	2	2016	Select Counties in Minnesota	Rochester area	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	143	0	1	04	01	H6609_143_0	4		1	07/07/2015	2016.01	07/07/2015 03:12:23 PM Eastern Daylight Time	08/04/2015 12:06:14 PM Eastern Daylight Time	07/30/2015 12:27:02 AM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-143 (PPO)	01	04		1			H6609	143	0	2016	Select Counties in Minnesota		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	144	1	1	04	01	H6609_144_1	3		1	07/08/2015	2016.01	07/08/2015 09:16:26 AM Eastern Daylight Time	07/31/2015 06:15:25 PM Eastern Daylight Time	07/30/2015 12:27:38 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-144 (PPO)	01	04		1			H6609	144	1	2016	Tidewater area	Tidewater area	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	144	2	1	04	01	H6609_144_2	3		1	07/08/2015	2016.01	07/08/2015 09:15:59 AM Eastern Daylight Time	07/31/2015 06:16:03 PM Eastern Daylight Time	07/30/2015 12:28:12 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-144 (PPO)	01	04		1			H6609	144	2	2016	Tidewater area	Tidewater area	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	145	0	1	04	01	H6609_145_0	3		1	07/08/2015	2016.01	07/08/2015 09:58:13 AM Eastern Daylight Time	07/31/2015 04:56:39 PM Eastern Daylight Time	07/30/2015 12:28:48 AM Eastern Daylight Time			08/04/2015 01:54:14 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-145 (PPO)	01	04		1			H6609	145	0	2016	Collin and Dallas counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	146	0	1	04	01	H6609_146_0	3		1	07/09/2015	2016.01	07/09/2015 01:14:43 PM Eastern Daylight Time	07/31/2015 05:20:18 PM Eastern Daylight Time	07/30/2015 12:29:24 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-146 (PPO)	01	04		1			H6609	146	0	2016	Select counties in Indiana and Kentucky		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6609	801	0	1	04	01	H6609_801_0	2		1	05/12/2015	2016.01	05/13/2015 11:45:17 AM Eastern Daylight Time	05/29/2015 11:10:35 AM Eastern Daylight Time				06/01/2015 11:44:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H6609	801	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H6609	802	0	1	04	01	H6609_802_0	2		1	05/13/2015	2016.01	05/13/2015 12:34:35 PM Eastern Daylight Time	05/29/2015 11:00:44 AM Eastern Daylight Time				06/01/2015 11:44:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H6609	802	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H6609	803	0	1	04	01	H6609_803_0	2		1	05/12/2015	2016.01	05/13/2015 11:46:30 AM Eastern Daylight Time	05/29/2015 11:01:16 AM Eastern Daylight Time				06/01/2015 11:44:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H6609	803	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H6609	805	0	2	04	01	H6609_805_0	2		1	05/14/2015	2016.01	05/14/2015 08:33:33 AM Eastern Daylight Time	05/29/2015 11:03:21 AM Eastern Daylight Time				06/01/2015 11:44:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H6609	805	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H6609	806	0	2	04	01	H6609_806_0	2		1	05/14/2015	2016.01	05/14/2015 08:17:39 AM Eastern Daylight Time	05/29/2015 11:03:57 AM Eastern Daylight Time				06/01/2015 11:44:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H6609	806	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H6609	807	0	2	04	01	H6609_807_0	2		1	05/14/2015	2016.01	05/14/2015 08:49:03 AM Eastern Daylight Time	05/29/2015 11:04:34 AM Eastern Daylight Time				06/01/2015 11:44:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H6609	807	0	2016	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H6609	816	0	1	04	01	H6609_816_0	1		1	05/13/2015	2016.01	05/13/2015 12:34:52 PM Eastern Daylight Time	05/29/2015 11:10:04 AM Eastern Daylight Time				05/29/2015 11:38:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H6609	816	0	2016	Bexar County		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
H6622	001	0	1	01	01	H6622_001_0	3		1	07/08/2015	2016.01	07/08/2015 02:18:14 PM Eastern Daylight Time	08/04/2015 11:35:05 AM Eastern Daylight Time	07/30/2015 12:29:58 AM Eastern Daylight Time			08/04/2015 01:18:24 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-001 (HMO)	01	01		1			H6622	001	0	2016	Green Bay area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	002	0	1	01	01	H6622_002_0	3		1	07/08/2015	2016.01	07/08/2015 01:31:00 PM Eastern Daylight Time	08/04/2015 11:45:07 AM Eastern Daylight Time	07/30/2015 12:30:34 AM Eastern Daylight Time			08/04/2015 01:18:24 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-002 (HMO)	01	01		1			H6622	002	0	2016	Milwaukee area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 02:44:44 PM Eastern Daylight Time	07/31/2015 06:12:02 PM Eastern Daylight Time	07/30/2015 12:18:04 PM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-004 (HMO)	01	01		1			H6622	004	0	2016	Richmond Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 02:44:53 PM Eastern Daylight Time	07/31/2015 06:12:36 PM Eastern Daylight Time	07/30/2015 12:18:40 PM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-005 (HMO)	01	01		1			H6622	005	0	2016	Tidewater area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/07/2015	2016.01	07/07/2015 03:25:14 PM Eastern Daylight Time	08/04/2015 11:08:33 AM Eastern Daylight Time	07/30/2015 12:32:22 AM Eastern Daylight Time			08/04/2015 01:11:35 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-007 (HMO)	01	01		1			H6622	007	0	2016	Select Counties in Montana		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3	2	1	07/31/2015	2016.01	07/31/2015 10:50:13 AM Eastern Daylight Time	08/04/2015 11:49:15 AM Eastern Daylight Time	07/30/2015 12:32:58 AM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus SNP-DE H6622-008 (HMO SNP)	01	01		1			H6622	008	0	2016	Select Counties in Montana		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	009	0	1	01	01	H6622_009_0	3		1	07/07/2015	2016.01	07/07/2015 03:12:54 PM Eastern Daylight Time	08/04/2015 12:11:06 PM Eastern Daylight Time	07/30/2015 12:33:34 AM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-009 (HMO)	01	01		1			H6622	009	0	2016	Western Montana area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	010	0	1	01	01	H6622_010_0	3		1	07/08/2015	2016.01	07/08/2015 11:15:11 AM Eastern Daylight Time	07/31/2015 06:13:44 PM Eastern Daylight Time	07/30/2015 12:34:10 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-010 (HMO)	01	01		1			H6622	010	0	2016	New Castle County		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	801	0	1	01	01	H6622_801_0	1		1	05/11/2015	2016.01	05/11/2015 02:41:38 PM Eastern Daylight Time	05/29/2015 08:20:12 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H6622	801	0	2016	Select counties in MT, DE and WI		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H6622	802	0	1	01	01	H6622_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:42:40 PM Eastern Daylight Time	05/29/2015 08:20:41 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H6622	802	0	2016	Select counties in MT, DE and WI		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H6623	001	0	1	01	01	H6623_001_0	5	2	1	08/04/2015	2016.01	08/04/2015 01:44:26 PM US Mountain Standard Time	08/04/2015 04:24:21 PM US Mountain Standard Time	08/04/2015 04:24:21 PM US Mountain Standard Time			08/05/2015 08:11:15 AM US Mountain Standard Time	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	Maricopa Care Advantage	www.mcareaz.com	Maricopa Care Advantage (HMO SNP)	01	01		1			H6623	001	0	2016	Maricopa County		2	1400	2			1	3		1	4			www.mcareaz.com/ProviderLookup.aspx	www.mcareaz.com/PartDResources.aspx	www.mcareaz.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	001	1	1	01	01	H6723_001_1	5		1	07/31/2015	2016.01	07/31/2015 09:42:17 AM Eastern Daylight Time	07/30/2015 04:07:07 PM Eastern Daylight Time	07/30/2015 04:07:30 PM Eastern Daylight Time			07/31/2015 01:23:37 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	1	2016	Ohio Regions	Region 1	2	2340	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	001	2	1	01	01	H6723_001_2	5		1	07/30/2015	2016.01	07/30/2015 03:00:56 PM Eastern Daylight Time	07/30/2015 04:07:01 PM Eastern Daylight Time	07/30/2015 04:07:30 PM Eastern Daylight Time			07/31/2015 01:23:37 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Classic (HMO)	01	01		1			H6723	001	2	2016	Ohio Regions	Region 2	2	275	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	1	1	01	01	H6723_002_1	7		1	07/31/2015	2016.01	07/31/2015 09:42:29 AM Eastern Daylight Time	07/30/2015 04:07:02 PM Eastern Daylight Time	07/30/2015 04:07:30 PM Eastern Daylight Time			07/31/2015 01:23:37 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	1	2016	Ohio Regions	Region 1	2	1170	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	002	2	1	01	01	H6723_002_2	7		1	07/30/2015	2016.01	07/30/2015 03:01:44 PM Eastern Daylight Time	07/30/2015 04:07:03 PM Eastern Daylight Time	07/30/2015 04:07:31 PM Eastern Daylight Time			07/31/2015 01:23:37 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage Choice (HMO)	01	01		1			H6723	002	2	2016	Ohio Regions	Region 2	2	138	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	801	0	1	01	01	H6723_801_0	1		1	05/21/2015	2016.01	05/21/2015 02:49:39 PM Eastern Daylight Time	05/28/2015 11:41:32 PM Eastern Daylight Time				05/29/2015 01:26:38 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	Medmutual.com/medicare	MedMutual Advantage EGWP (Calendar Year) (HMO)	01	01		1			H6723	801	0	2016	Ohio Regions		1	50	2			2							Medmutual.com/medicare	Medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;8b1;9a;9b;10a;11a;11b;	2		1					1	2			
H6723	802	0	1	01	01	H6723_802_0	1		1	05/21/2015	2016.01	05/21/2015 02:51:02 PM Eastern Daylight Time	05/28/2015 11:41:56 PM Eastern Daylight Time				05/29/2015 01:26:38 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (Non-Calendar Year) (HMO)	01	01		1			H6723	802	0	2016	Ohio Regions		1	50	2			2							medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;8a;8b1;9a;9b;10a;11a;11b;	2		1					1	2			
H6723	803	0	1	01	01	H6723_803_0	1		1	05/21/2015	2016.01	05/21/2015 02:53:25 PM Eastern Daylight Time	05/28/2015 11:42:22 PM Eastern Daylight Time				05/29/2015 01:26:38 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/medicare	MedMutual Advantage EGWP (MA-Only) (HMO)	01	01		1			H6723	803	0	2016	Ohio Regions		1	50	2			2							medmutual.com/medicare	medmutual.com/medicare	medmutual.com/medicare	(800)982-3117		(800)982-3117				(866)406-8777										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;8a;8b1;9a;9b;10a;11a;11b;	2		1					1	2			
H6743	001	0	1	04	01	H6743_001_0	7		1	07/15/2015	2016.01	07/15/2015 03:39:31 PM Pacific Daylight Time	08/04/2015 04:26:52 PM Pacific Daylight Time	08/03/2015 09:50:06 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze Rx (Basin) (PPO)	01	04		1			H6743	001	0	2016	Klamath County		2	1525	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	002	0	1	04	01	H6743_002_0	6		1	07/06/2015	2016.01	07/06/2015 10:23:01 AM Pacific Daylight Time	08/04/2015 04:27:06 PM Pacific Daylight Time				08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver (PPO)	01	04		1			H6743	002	0	2016	Douglas and Klamath Counties		2	289	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2						2			
H6743	003	0	1	04	01	H6743_003_0	7		1	08/03/2015	2016.01	08/03/2015 08:45:27 AM Pacific Daylight Time	08/04/2015 04:27:24 PM Pacific Daylight Time	08/03/2015 09:50:24 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver Rx (PPO)	01	04		1			H6743	003	0	2016	Douglas and Klamath Counties		2	1080	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	004	0	1	04	01	H6743_004_0	7		1	07/06/2015	2016.01	07/06/2015 09:13:54 AM Pacific Daylight Time	08/04/2015 04:27:38 PM Pacific Daylight Time	08/03/2015 09:50:34 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Gold Rx (PPO)	01	04		1			H6743	004	0	2016	Douglas and Klamath Counties		2	1408	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	006	0	1	04	01	H6743_006_0	6		1	07/01/2015	2016.01	07/01/2015 01:33:48 PM Pacific Daylight Time	08/04/2015 04:27:52 PM Pacific Daylight Time				08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze (PPO)	01	04		1			H6743	006	0	2016	Douglas and Klamath Counties		2	383	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2						2			
H6743	007	0	1	04	01	H6743_007_0	7		1	07/01/2015	2016.01	07/01/2015 01:33:59 PM Pacific Daylight Time	08/04/2015 04:28:04 PM Pacific Daylight Time	08/03/2015 09:50:44 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze Rx (Umpqua) (PPO)	01	04		1			H6743	007	0	2016	Douglas County		2	2347	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	013	0	1	04	01	H6743_013_0	5		1	07/01/2015	2016.01	07/01/2015 01:34:26 PM Pacific Daylight Time	08/04/2015 04:28:38 PM Pacific Daylight Time				08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze (Rogue) (PPO)	01	04		1			H6743	013	0	2016	Josephine and Jackson Counties		2	85	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2						2			
H6743	014	0	1	04	01	H6743_014_0	6		1	07/01/2015	2016.01	07/01/2015 01:34:21 PM Pacific Daylight Time	08/04/2015 04:28:52 PM Pacific Daylight Time	08/03/2015 09:49:20 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze Rx (Rogue) (PPO)	01	04		1			H6743	014	0	2016	Josephine and Jackson Counties		2	192	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	015	0	1	04	01	H6743_015_0	5		1	07/06/2015	2016.01	07/06/2015 09:14:27 AM Pacific Daylight Time	08/04/2015 04:29:04 PM Pacific Daylight Time				08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver (Rogue) (PPO)	01	04		1			H6743	015	0	2016	Josephine and Jackson Counties		2	40	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2						2			
H6743	016	0	1	04	01	H6743_016_0	6		1	07/06/2015	2016.01	07/06/2015 09:14:52 AM Pacific Daylight Time	08/04/2015 04:29:20 PM Pacific Daylight Time	08/03/2015 09:49:28 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver Rx (Rogue) (PPO)	01	04		1			H6743	016	0	2016	Josephine and Jackson Counties		2	190	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6743	017	0	1	04	01	H6743_017_0	7		1	07/06/2015	2016.01	07/06/2015 09:15:17 AM Pacific Daylight Time	08/04/2015 04:29:38 PM Pacific Daylight Time	08/03/2015 09:49:36 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Gold Rx (Rogue) (PPO)	01	04		1			H6743	017	0	2016	Josephine and Jackson Counties		2	38	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H6745	001	0	1	01	01	H6745_001_0	7		1	08/04/2015	2016.01	08/04/2015 04:05:22 PM Eastern Daylight Time	08/04/2015 10:57:54 PM Eastern Daylight Time	08/05/2015 10:59:28 AM Eastern Daylight Time			08/05/2015 01:54:33 PM Eastern Daylight Time	AMIDA CARE INC.	Amida Care	www.amidacareny.org	Amida Care True Life Plus (HMO)	01	01		1			H6745	001	0	2016	Bronx,Kings,New York,Queens,Richmond Counties		2	200	2			2							www.amidacareny.org	www.amidacareny.org	www.amidacareny.org	(888)963-7092		(888)963-7092		(888)963-7093		(888)963-7093		(844)569-2835		(844)569-2835		(888)963-7093		(888)963-7093		(711)-		(711)-		(711)-		(711)-		(800)716-3231		(800)716-3231		(711)-		(711)-		2					2					2	2			
H6745	002	0	1	01	01	H6745_002_0	4	2	1	08/05/2015	2016.01	08/05/2015 01:57:52 PM Eastern Daylight Time	08/04/2015 10:40:26 PM Eastern Daylight Time	08/05/2015 10:59:42 AM Eastern Daylight Time			08/05/2015 02:00:43 PM Eastern Daylight Time	AMIDA CARE INC.	Amida Care	www.amidacareny.org	Amida Care True Life Advantage (HMO SNP)	01	01		1			H6745	002	0	2016	Bronx,Kings,New York,Queens,Richmond Counties		2	216	2			1	3		1	3		1	www.amidacareny.org	www.amidacareny.org	www.amidacareny.org	(888)963-7092		(888)963-7092		(888)963-7093		(888)963-7093		(844)569-2835		(844)569-2835		(888)963-7093		(888)963-7093		(711)-		(711)-		(711)-		(711)-		(800)716-3231		(800)716-3231		(711)-		(711)-		2					2					2	2			
H6745	003	0	1	01	01	H6745_003_0	6		1	08/04/2015	2016.01	08/04/2015 04:10:44 PM Eastern Daylight Time	08/04/2015 10:47:18 PM Eastern Daylight Time	08/05/2015 11:00:00 AM Eastern Daylight Time			08/05/2015 02:06:19 PM Eastern Daylight Time	AMIDA CARE INC.	Amida Care	www.amidacareny.org	Amida Care Live Life Advantage (HMO SNP)	01	01		1			H6745	003	0	2016	Bronx,Kings,New York,Queens,Richmond Counties		2	704	2			1	4		1		00000000001000000000		www.amidacareny.org	www.amidacareny.org	www.amidacareny.org	(888)963-7092		(888)963-7092		(888)963-7093		(888)963-7093		(844)569-2835		(844)569-2835		(888)963-7093		(888)963-7093		(711)-		(711)-		(711)-		(711)-		(800)716-3231		(800)716-3231		(711)-		(711)-		2					2					2	2			
H6750	001	0	1	01	01	H6750_001_0	8		1	07/09/2015	2016.01	07/09/2015 01:18:25 PM Eastern Daylight Time	08/03/2015 04:03:57 PM Eastern Daylight Time	07/31/2015 02:19:59 PM Eastern Daylight Time			08/04/2015 05:46:07 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	001	0	2016	Southern New Hampshire		2	1354	2			2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	002	0	1	01	01	H6750_002_0	8		1	08/04/2015	2016.01	08/04/2015 05:29:04 PM Eastern Daylight Time	08/03/2015 03:46:37 PM Eastern Daylight Time	07/31/2015 02:11:34 PM Eastern Daylight Time			08/04/2015 05:46:07 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H6750	002	0	2016	Southern New Hampshire		2	2883	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	801	0	1	01	01	H6750_801_0	5		1	08/20/2015	2016.01	08/20/2015 12:49:49 PM Eastern Daylight Time	08/20/2015 10:19:02 AM Eastern Daylight Time				08/20/2015 12:53:27 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	801	0	2016	National		1	67	2			2							www.harvardpilgrim.org	www.harvardpilgrim.org	www.harvardpilgrim.org	(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)-		1	2		2		1					1	2			
H6750	802	0	1	01	01	H6750_802_0	5		1	05/07/2015	2016.01	05/07/2015 11:26:18 AM Eastern Daylight Time	08/20/2015 10:31:22 AM Eastern Daylight Time				08/20/2015 12:53:27 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	802	0	2016	National		1	67	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)-		1	2		2		1					1	2			
H6750	803	0	1	01	01	H6750_803_0	5		1	05/07/2015	2016.01	05/07/2015 11:26:28 AM Eastern Daylight Time	08/20/2015 10:32:52 AM Eastern Daylight Time				08/20/2015 12:53:27 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H6750	803	0	2016	New Hampshire		1	67	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)-		1	2		2		1					1	2			
H6750	804	0	1	01	01	H6750_804_0	5		1	05/07/2015	2016.01	05/07/2015 11:26:37 AM Eastern Daylight Time	08/20/2015 10:33:53 AM Eastern Daylight Time				08/20/2015 12:53:27 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.hpforlife.org	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H6750	804	0	2016	New Hampshire		1	67	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)-		1	2		2		1					1	2			
H6751	001	0	1	48	05	H6751_001_0	6		1	08/25/2015	2016.01	08/25/2015 12:52:12 PM Central Daylight Time					08/25/2015 01:59:42 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring CarePlan of Illinois	www.CarePlanIL.com	Cigna-HealthSpring CarePlan of Illinois (Medicare-Medicaid Plan)	05	48		1			H6751	001	0	2016	Greater Chicago Area		2		2			2							www.CarePlanIL.com	www.CarePlanIL.com	www.mycignahealthspring.com	(866)487-4331		(866)487-4331		(888)886-1993		(888)886-1993		(866)487-4331		(866)487-4331		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H6776	001	0	1	01	01	H6776_001_0	4		1	08/05/2015	2016.01	08/05/2015 09:49:42 AM Eastern Daylight Time	08/05/2015 10:02:50 AM Eastern Daylight Time	08/05/2015 10:03:22 AM Eastern Daylight Time			08/05/2015 01:22:38 PM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	RiverSpring Star	riverspringstar.org	RiverSpring Star (HMO SNP)	01	01		1			H6776	001	0	2016	Counties: Brx, Ki, Na, NY, Qu, Ri, Wes		2	485	2			1	1	3	1				riverspringstar.org	riverspringstar.org	MeridianRx.com	(800)580-7000		(800)580-7000		(800)580-7000		(800)580-7000		(855)898-1482		(313)324-3800		(855)898-1482		(313)324-3800		(711)-		(711)-		(711)-		(711)-		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					1					1	2			
H6786	002	0	1	04	01	H6786_002_0	8		1	07/20/2015	2016.01	07/20/2015 03:25:27 PM Eastern Daylight Time	08/01/2015 09:47:10 PM Eastern Daylight Time	07/30/2015 06:37:39 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H6786	002	0	2016	Select Counties in Maine		2	28	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)304-1785		(855)304-1785		(800)797-6458		(800)797-6458		(855)304-1785		(855)304-1785		(844)373-7114		(844)373-7114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6786	801	0	1	04	01	H6786_801_0	5		1	05/29/2015	2016.01	05/29/2015 12:31:24 PM Pacific Daylight Time	05/31/2015 09:39:04 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H6786	801	0	2016	Maine		1	50	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647		(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H6786	802	0	1	04	01	H6786_802_0	5		1	05/29/2015	2016.01	05/29/2015 12:31:52 PM Pacific Daylight Time	05/31/2015 01:17:33 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H6786	802	0	2016	Maine		1	50	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H6786	803	0	1	04	01	H6786_803_0	5		1	05/29/2015	2016.01	05/29/2015 12:32:14 PM Pacific Daylight Time	05/31/2015 01:17:38 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H6786	803	0	2016	Maine		1	50	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647		(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H6787	001	0	1	20	08	H6787_001_0	1		1	05/28/2015	2016.01	05/28/2015 09:16:35 AM Central Daylight Time		05/28/2015 08:59:25 AM Central Daylight Time			05/28/2015 09:18:08 AM Central 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	2016	Ingham, Eaton, and Clinton Counties		2		2			2								http://seniorcommunitycaremi.org	http://seniorcommunitycaremi.org									(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000										(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000																
H6787	002	0	1	20	08	H6787_002_0	1		1	05/28/2015	2016.01	05/28/2015 09:15:50 AM Central Daylight Time		05/28/2015 08:59:42 AM Central Daylight Time			05/28/2015 09:18:08 AM Central 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	2016	Eaton, Ingham and Clinton County		2		2			2								http://seniorcommunitycaremi.org	http://seniorcommunitycaremi.org									(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000										(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000																
H6801	002	0	1	01	01	H6801_002_0	7		1	07/16/2015	2016.01	07/16/2015 12:51:24 PM Central Daylight Time	08/03/2015 03:35:54 PM Central Daylight Time	08/03/2015 02:34:56 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	GHS MANAGED HEALTH CARE PLANS, INC.	Blue Cross Blue Shield of Oklahoma	www.mybluemedicareok.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H6801	002	0	2016	Greater Oklahoma Area		2		2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(866)796-5709		(866)796-5709		(877)583-8129		(877)583-8129		(866)796-5709		(866)796-5709		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6801	006	0	1	02	01	H6801_006_0	8		1	07/16/2015	2016.01	07/16/2015 12:51:51 PM Central Daylight Time	08/03/2015 03:36:28 PM Central Daylight Time	08/03/2015 02:37:50 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	GHS MANAGED HEALTH CARE PLANS, INC.	Blue Cross Blue Shield of Oklahoma	www.mybluemedicareok.com	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H6801	006	0	2016	Greater Oklahoma Area		2		2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(866)796-5709		(866)796-5709		(877)583-8129		(877)583-8129		(866)796-5709		(866)796-5709		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	003	1	1	01	01	H6815_003_1	5		1	08/04/2015	2016.01	08/04/2015 10:34:39 AM Pacific Daylight Time	08/03/2015 10:30:30 AM Pacific Daylight Time	07/29/2015 05:09:42 PM Pacific Daylight Time			08/04/2015 10:45:21 AM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	www.healthnet.com/medicare	Health Net Ruby (HMO)	01	01		1			H6815	003	1	2016	OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM	Clackamas, Multnomah, Washington OR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	003	2	1	01	01	H6815_003_2	5		1	08/04/2015	2016.01	08/04/2015 10:35:19 AM Pacific Daylight Time	08/03/2015 10:31:14 AM Pacific Daylight Time	07/29/2015 05:09:56 PM Pacific Daylight Time			08/04/2015 10:45:21 AM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	www.healthnet.com/medicare	Health Net Ruby (HMO)	01	01		1			H6815	003	2	2016	OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM	OR Counties BE, LA, LN, MN, PK, YM	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	004	1	1	01	01	H6815_004_1	3		1	07/30/2015	2016.01	07/30/2015 10:47:03 AM Pacific Daylight Time	08/03/2015 10:31:58 AM Pacific Daylight Time	07/29/2015 05:10:10 PM Pacific Daylight Time			08/03/2015 05:55:53 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	www.healthnet.com/medicare	Health Net Jade (HMO SNP)	01	01		1			H6815	004	1	2016	OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM	Clackamas, Multnomah, Washington, OR	2		2			1	4		1		00000000000000000010		www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6815	004	2	1	01	01	H6815_004_2	3		1	07/30/2015	2016.01	08/03/2015 05:49:15 PM Pacific Daylight Time	08/03/2015 10:32:56 AM Pacific Daylight Time	07/29/2015 05:10:24 PM Pacific Daylight Time			08/03/2015 05:55:53 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	www.healthnet.com/medicare	Health Net Jade (HMO SNP)	01	01		1			H6815	004	2	2016	OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM	OR Counties BE, LA, LN, MN, PK, YM	2		2			1	4		1		00000000000000000010		www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6846	001	0	1	20	08	H6846_001_0	1		1	05/21/2015	2016.01	05/21/2015 11:45:49 AM Eastern Daylight Time		05/21/2015 11:40:54 AM Eastern Daylight Time			05/21/2015 11:48:24 AM Eastern Daylight Time	COMMUNITY CAREPARTNERS, INC.	CarePartners PACE	http://www.carepartners.org	Community CarePartners, Inc (PACE)	08	20		1			H6846	001	0	2016	Buncombe and Henderson Counties		2		2			2								www.carepartners.org	www.carepartners.org									(800)000-0000		(828)213-8442		(800)000-0000		(828)213-8442										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6846	002	0	1	20	08	H6846_002_0	1		1	05/21/2015	2016.01	05/21/2015 11:46:45 AM Eastern Daylight Time		05/21/2015 11:42:12 AM Eastern Daylight Time			05/21/2015 11:48:24 AM Eastern Daylight Time	COMMUNITY CAREPARTNERS, INC.	CarePartners PACE	http://www.carepartners.org	Community CarePartners, Inc (PACE)	08	20		1			H6846	002	0	2016	Buncombe and Henderson Counties		2		2			2								www.carepartners.org	www.carepartners.org									(800)000-0000		(828)213-8442		(800)000-0000		(828)213-8442										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6859	001	0	1	01	01	H6859_001_0	3		1	07/08/2015	2016.01	07/08/2015 02:45:17 PM Eastern Daylight Time	07/31/2015 06:08:45 PM Eastern Daylight Time	07/30/2015 12:34:44 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Gold Plus H6859-001 (HMO)	01	01		1			H6859	001	0	2016	South Central Pennsylvania area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6859	003	0	1	01	01	H6859_003_0	3		1	07/08/2015	2016.01	07/08/2015 09:22:36 AM Eastern Daylight Time	07/31/2015 06:09:18 PM Eastern Daylight Time	07/30/2015 12:35:20 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Gold Plus H6859-003 (HMO)	01	01		1			H6859	003	0	2016	Northeast Pennsylvania area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6859	004	0	1	01	01	H6859_004_0	3		1	07/08/2015	2016.01	07/08/2015 02:45:30 PM Eastern Daylight Time	07/31/2015 06:09:49 PM Eastern Daylight Time	07/30/2015 12:35:56 AM Eastern Daylight Time			08/04/2015 12:49:50 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Gold Plus H6859-004 (HMO)	01	01		1			H6859	004	0	2016	Greater Philadelphia Metro Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6859	007	0	1	01	01	H6859_007_0	3		1	07/08/2015	2016.01	07/08/2015 02:55:43 PM Eastern Daylight Time	07/31/2015 05:53:33 PM Eastern Daylight Time	07/30/2015 12:36:32 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Gold Plus H6859-007 (HMO)	01	01		1			H6859	007	0	2016	Lawrence and Mercer counties		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6859	801	0	1	01	01	H6859_801_0	1		1	05/11/2015	2016.01	05/11/2015 02:43:42 PM Eastern Daylight Time	05/29/2015 08:30:22 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H6859	801	0	2016	Select Counties in Pennslyvania		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H6859	802	0	1	01	01	H6859_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:44:45 PM Eastern Daylight Time	05/29/2015 08:30:53 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H6859	802	0	2016	Select Counties in Pennsylvania		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H6864	001	0	1	01	01	H6864_001_0	9	2	1	08/03/2015	2016.01	08/03/2015 03:58:56 PM Eastern Daylight Time	08/04/2015 03:19:56 PM Eastern Daylight Time	08/04/2015 03:19:58 PM Eastern Daylight Time			08/05/2015 08:05:01 AM Eastern Daylight Time	GUILDNET, INC.	GuildNet	www.guildnetny.org	GuildNet Gold (HMO SNP)	01	01		1			H6864	001	0	2016	Bronx, Kings, NY, Queens, Nassau, Suffolk, RI, Wes		2		2			1	3		1	5			www.guildnetny.org	www.guildnetny.org	www.guildnetny.org	(800)815-0000		(800)815-0000		(800)815-0000		(800)815-0000		(877)444-3973		(877)444-3973		(800)815-0000		(800)815-0000		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)248-0640		(866)248-0640		(800)662-1220		(800)662-1220		2					2					2	2			
H6870	001	0	1	48	05	H6870_001_0	4		1	08/27/2015	2016.01	08/27/2015 12:40:37 PM Central Daylight Time					08/27/2015 04:10:00 PM Central Daylight Time	SUPERIOR HEALTH PLAN, INC.	Superior HealthPlan	http://mmp.superiorhealthplan.com	Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan)	05	48		1			H6870	001	0	2016	Bexar, Dallas, Hidalgo Counties		2	1000	2			2							http://apps.superiorhealthplan.com/findadoc/legacy/selectProduct?busLine=TX	http://mmp.superiorhealthplan.com/home/prescription-drug-part-d-benefit-information/	http://apps.superiorhealthplan.com/findadoc/legacy/selectProduct?busLine=TX	(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)-		2					2					2				
H6887	001	0	1	20	08	H6887_001_0	1		1	05/21/2015	2016.01	05/21/2015 01:29:11 PM Eastern Daylight Time		05/18/2015 05:16:04 PM Eastern Daylight Time			05/21/2015 01:30:56 PM Eastern Daylight Time	SOUTH JERSEY HEALTHCARE LIFE, INC.	Inspira Health Network LIFE	www.inspirahealthnetwork.org	Inspira Health Network LIFE (PACE)	08	20		1			H6887	001	0	2016	Inspira Health Network LIFE		2		2			2								http://www.inspirahealthnetwork.org/	http://www.inspirahealthnetwork.org/									(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4516										(855)295-5433		(856)632-4516		(855)295-5433		(856)362-4516																
H6887	002	0	1	20	08	H6887_002_0	1		1	05/21/2015	2016.01	05/21/2015 01:27:39 PM Eastern Daylight Time		05/18/2015 05:23:15 PM Eastern Daylight Time			05/21/2015 01:30:56 PM Eastern Daylight Time	SOUTH JERSEY HEALTHCARE LIFE, INC.	Inspira Health Network LIFE	www.inspirahealthnetwork.org	Inspira Health Network LIFE (PACE)	08	20		1			H6887	002	0	2016	Inspira Health Network LIFE		2		2			2								http://www.inspirahealthnetwork.org/	http://www.inspirahealthnetwork.org/									(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4516										(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4516																
H6941	001	0	1	20	08	H6941_001_0	1		1	05/28/2015	2016.01	05/28/2015 04:55:53 PM Central Daylight Time		05/26/2015 09:03:54 AM Central Daylight Time			05/28/2015 04:59:33 PM Central Daylight Time	LIFE PACE	LIFE PACE, INC.	WWW.LIFESENIORSERVICES.ORG	LIFE PACE Dual Eligible 001 (PACE)	08	20		1			H6941	001	0	2016	Tulsa County		2		2			2								www.lifeseniorservices.org	www.carekinesis.com									(844)664-4440		(918)664-9000		(844)664-4440		(918)664-9000										(844)664-4440		(918)664-1234		(844)664-4440		(918)664-1234																
H6941	002	0	1	20	08	H6941_002_0	1		1	05/28/2015	2016.01	05/28/2015 04:56:33 PM Central Daylight Time		05/26/2015 09:04:57 AM Central Daylight Time			05/28/2015 04:59:33 PM Central Daylight Time	LIFE PACE	LIFE PACE, INC.	WWW.LIFESENIORSERVICES.ORG	LIFE PACE Medicare Only 002 (PACE)	08	20		1			H6941	002	0	2016	Tulsa County		2		2			2								www.lifeseniorservices.org	www.carekinesis.com									(844)664-4440		(918)664-9000		(844)664-4440		(918)664-9000										(844)664-4440		(918)664-1234		(844)664-4440		(918)664-1234																
H6947	001	0	1	01	01	H6947_001_0	5		1	07/13/2015	2016.01	07/13/2015 08:34:29 AM Central Daylight Time	07/29/2015 04:16:44 PM Central Daylight Time	07/29/2015 02:07:50 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	QUALCHOICE ADVANTAGE	QualChoice Advantage	www.qualchoiceadvantage.com	Classic Plus Rx (HMO)	01	01		1			H6947	001	0	2016	Little Rock - Hot Springs AR		2	1433	2			2							http://www.qualchoiceadvantage.com/	http://www.qualchoiceadvantage.com/	http://www.qualchoiceadvantage.com/	(844)822-7838		(844)822-7838		(844)822-7838		(844)822-7838		(844)822-7838		(844)822-7838		(844)822-7838		(844)822-7838		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6951	001	0	1	04	01	H6951_001_0	3		1	07/16/2015	2016.01	07/16/2015 09:06:22 AM Pacific Daylight Time	06/01/2015 05:11:32 PM Pacific Daylight Time				07/16/2015 09:49:08 AM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage Pioneer (PPO)	01	04		1			H6951	001	0	2016	Lane County		2	166	2			2							www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950										(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951										2					2						2			
H6951	002	0	1	04	01	H6951_002_0	6		1	08/05/2015	2016.01	08/05/2015 05:26:45 PM Pacific Daylight Time	08/05/2015 12:17:18 PM Pacific Daylight Time	08/05/2015 10:50:58 AM Pacific Daylight Time			08/05/2015 07:59:14 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage Pioneer Rx (PPO)	01	04		1			H6951	002	0	2016	Lane County		2	369	2			2							www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2						2			
H6972	001	0	1	01	01	H6972_001_0	4		1	07/09/2015	2016.01	07/09/2015 03:17:44 PM Central Daylight Time	07/31/2015 09:11:43 AM Central Daylight Time	07/30/2015 08:32:46 AM Central Daylight Time			08/03/2015 09:24:52 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H6972	001	0	2016	Select counties in Arkansas		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6974	001	0	1	48	05	H6974_001_0	5		1	08/25/2015	2016.01	08/25/2015 03:22:57 PM Eastern Daylight Time					08/25/2015 03:24:52 PM Eastern Daylight Time	ALPHACARE OF NEW YORK, INC.	Alphacare of New York, Inc.	www.alphacare.com	AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H6974	001	0	2016	Kings, Queens, Bronx and New York Counties		2		2			2							www.alphacare.com	www.alphacare.com	www.alphacare.com	(855)632-5742		(855)632-5742		(855)632-5742		(855)632-5742		(855)632-5742		(855)632-5742		(855)632-5742		(855)632-5742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H6988	001	0	1	01	01	H6988_001_0	9		1	08/05/2015	2016.01	08/05/2015 02:04:05 PM Eastern Daylight Time	08/04/2015 10:22:41 AM Eastern Daylight Time	08/04/2015 10:23:55 AM Eastern Daylight Time			08/05/2015 02:07:45 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	2016	NYC Metro Area, Rockland, Erie, Niagara Counties		2	287	2			2							www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H6988	002	0	1	01	01	H6988_002_0	6	2	1	08/04/2015	2016.01	08/04/2015 10:52:16 AM Eastern Daylight Time	08/04/2015 10:35:09 AM Eastern Daylight Time	08/04/2015 10:24:43 AM Eastern Daylight Time			08/04/2015 11:16:26 AM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Dual Coverage Care (HMO SNP)	01	01		1			H6988	002	0	2016	Kings,Queens,Bronx,Manhattan and Richmond Counties		2		2			1	3		1	2			www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H6988	003	0	1	01	01	H6988_003_0	7		1	08/05/2015	2016.01	08/05/2015 02:04:45 PM Eastern Daylight Time	08/04/2015 10:25:05 AM Eastern Daylight Time	08/04/2015 10:21:10 AM Eastern Daylight Time			08/05/2015 02:07:45 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 SNP)	01	01		1			H6988	003	0	2016	NYC Metro Area, Rockland, Erie, Niagara Counties		2	287	2			1	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		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2	2			
H6988	801	0	1	01	01	H6988_801_0	3		1	05/28/2015	2016.01	05/28/2015 02:11:38 PM Eastern Daylight Time	07/17/2015 01:50:34 PM Eastern Daylight Time				07/17/2015 01:52:37 PM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Healthy Living Employer Group (HMO)	01	01		1			H6988	801	0	2016	NYC Metro Area, Rockland, Erie, Niagara Counties		1		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		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		1	1	1a;1b;2;3-1;5;6;7b;7c;7f;7g;7i;8b1;8b2;9a;9b;9c;11a;11b;12;14d;14e;15;	1	7b;7f;7g;7h;	1					1	2			
H7003	001	0	1	20	08	H7003_001_0	1		1	05/21/2015	2016.01	05/21/2015 07:20:43 PM Central Daylight Time		05/21/2015 08:40:28 AM Central Daylight Time			05/21/2015 07:22:20 PM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways	immanuelpathways.org	Immanuel Pathways-PACE NE (PACE)	08	20		1			H7003	001	0	2016	PACE Nebraska		2		2			2								www.immanuelpathways,org	http://www.immanuelpathways.org/									(800)000-0000		(402)991-0330		(800)000-0000		(402)991-0330										(800)829-2992		(402)991-0330		(800)829-2992		(402)991-0330																
H7003	002	0	1	20	08	H7003_002_0	1		1	05/21/2015	2016.01	05/21/2015 07:21:00 PM Central Daylight Time		05/21/2015 08:41:46 AM Central Daylight Time			05/21/2015 07:22:20 PM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways	immanuelpathways.org	Immanuel Pathways-PACE NE (PACE)	08	20		1			H7003	002	0	2016	PACE Nebraska		2		2			2								www.immanuelpathways,org	http://www.immanuelpathways.org/									(800)000-0000		(402)991-0330		(800)000-0000		(402)991-0330										(800)829-2992		(402)991-0330		(800)829-2992		(402)991-0330																
H7006	001	0	1	04	01	H7006_001_0	6		1	07/06/2015	2016.01	07/06/2015 09:15:48 AM Pacific Daylight Time	08/04/2015 04:30:06 PM Pacific Daylight Time	08/03/2015 09:48:34 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Gold Rx (Willamette) (PPO)	01	04		1			H7006	001	0	2016	Marion and Polk Counties in Oregon		2	1896	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H7006	003	0	1	04	01	H7006_003_0	6		1	07/06/2015	2016.01	07/06/2015 09:16:09 AM Pacific Daylight Time	08/04/2015 04:30:20 PM Pacific Daylight Time	08/03/2015 09:48:42 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver Rx (Willamette) (PPO)	01	04		1			H7006	003	0	2016	Marion and Polk Counties		2	1014	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H7006	005	0	1	04	01	H7006_005_0	7		1	07/06/2015	2016.01	07/06/2015 09:16:36 AM Pacific Daylight Time	08/04/2015 04:30:42 PM Pacific Daylight Time	08/03/2015 09:48:50 AM Pacific Daylight Time			08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze Rx (Willamette) (PPO)	01	04		1			H7006	005	0	2016	Marion and Polk Counties		2	55	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2						2			
H7006	006	0	1	04	01	H7006_006_0	5		1	07/01/2015	2016.01	07/01/2015 01:30:16 PM Pacific Daylight Time	08/04/2015 04:31:02 PM Pacific Daylight Time				08/05/2015 01:43:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze (Willamette) (PPO)	01	04		1			H7006	006	0	2016	Marion and Polk Counties		2	239	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2						2			
H7020	001	0	1	01	01	H7020_001_0	4		1	07/14/2015	2016.01	07/14/2015 04:02:35 PM Central Daylight Time	08/01/2015 09:49:14 AM Central Daylight Time	07/30/2015 08:33:14 AM Central Daylight Time			08/03/2015 04:10:23 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H7020	001	0	2016	South Carolina		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	801	0	1	01	01	H7020_801_0	3		1	05/21/2015	2016.01	05/21/2015 09:04:20 PM Central Daylight Time	07/12/2015 09:59:15 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H7020	801	0	2016	South Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H7020	802	0	1	02	01	H7020_802_0	3		1	05/21/2015	2016.01	05/21/2015 09:04:34 PM Central Daylight Time	07/12/2015 09:59:45 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H7020	802	0	2016	South Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H7020	803	0	1	01	01	H7020_803_0	3		1	05/21/2015	2016.01	05/21/2015 09:04:51 PM Central Daylight Time	07/12/2015 10:00:14 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H7020	803	0	2016	South Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(886)659-3446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H7020	804	0	1	02	01	H7020_804_0	3		1	05/21/2015	2016.01	05/21/2015 09:05:02 PM Central Daylight Time	07/12/2015 10:00:44 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H7020	804	0	2016	South Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H7020	805	0	1	01	01	H7020_805_0	3		1	05/21/2015	2016.01	05/21/2015 09:05:16 PM Central Daylight Time	07/12/2015 10:01:13 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H7020	805	0	2016	South Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H7020	806	0	1	02	01	H7020_806_0	3		1	05/21/2015	2016.01	05/21/2015 09:05:29 PM Central Daylight Time	07/12/2015 10:01:47 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H7020	806	0	2016	South Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H7114	001	0	1	20	08	H7114_001_0	1		1	05/20/2015	2016.01	05/20/2015 01:22:47 PM Central Daylight Time		05/19/2015 04:05:41 PM Central Daylight Time			05/20/2015 01:23:50 PM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valir.com	Dual (PACE)	08	20		1			H7114	001	0	2016	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	05/20/2015	2016.01	05/20/2015 01:20:08 PM Central Daylight Time		05/19/2015 04:05:41 PM Central Daylight Time			05/20/2015 01:23:50 PM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valir.com	Medicare Only (PACE)	08	20		1			H7114	002	0	2016	Oklahoma County		2		2			2								www.valir.com	www.valir.com									(888)898-2080		(405)609-3688		(888)898-8020		(405)609-3688										(711)-		(711)-		(711)-		(711)-																
H7115	001	0	1	01	01	H7115_001_0	7		1	07/17/2015	2016.01	07/17/2015 01:42:31 PM Central Daylight Time	07/30/2015 09:17:37 AM Central Daylight Time	07/30/2015 09:23:55 AM Central Daylight Time			08/04/2015 02:59:06 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan, Inc.	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	001	0	2016	Texas Counties - Harris, Montgomery, Fort Bend		2		2			2							healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org	healthplan.memorialhermann.org	(844)550-6886		(844)550-6886		(888)897-1337		(888)897-1337		(844)860-6750		(844)860-6750		(888)897-1337		(888)897-1337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	801	0	1	01	01	H7115_801_0	4		1	07/13/2015	2016.01	07/13/2015 12:28:04 PM Central Daylight Time	06/29/2015 11:17:44 AM Central Daylight Time				07/16/2015 03:06:57 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan, Inc.	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	801	0	2016	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org	healthplan.memorialhermann.org	(844)550-6886		(844)550-6886		(888)897-1337		(888)897-1337		(844)860-6750		(844)860-6750		(888)897-1337		(888)897-1337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	802	0	1	01	01	H7115_802_0	4		1	07/13/2015	2016.01	07/13/2015 12:28:41 PM Central Daylight Time	07/15/2015 10:50:14 AM Central Daylight Time				07/16/2015 03:06:57 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan, Inc.	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	802	0	2016	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org	healthplan.memorialhermann.org	(844)550-6886		(844)550-6886		(888)897-1337		(888)897-1337		(844)860-6750		(844)860-6750		(888)897-1337		(888)897-1337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	803	0	1	01	01	H7115_803_0	4		1	07/13/2015	2016.01	07/13/2015 12:29:01 PM Central Daylight Time	06/29/2015 11:19:15 AM Central Daylight Time				07/16/2015 03:06:57 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan, Inc.	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	01	01		1			H7115	803	0	2016	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org	healthplan.memorialhermann.org	(844)550-6886		(844)550-6886		(888)897-1337		(888)897-1337										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7149	001	0	1	01	01	H7149_001_0	5		1	07/31/2015	2016.01	07/31/2015 10:32:16 AM Central Daylight Time	08/02/2015 07:21:32 PM Central Daylight Time	07/29/2015 04:56:47 PM Central Daylight Time			08/02/2015 10:12:18 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver (HMO)	01	01		1			H7149	001	0	2016	Partial State of Nebraska		2	3800	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(800)707-7051		(800)707-7051		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	004	0	1	01	01	H7149_004_0	6		1	07/31/2015	2016.01	07/31/2015 10:32:34 AM Central Daylight Time	08/02/2015 07:24:02 PM Central Daylight Time	07/29/2015 04:57:07 PM Central Daylight Time			08/02/2015 10:12:18 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (HMO)	01	01		1			H7149	004	0	2016	Douglas and Sarpy Counties Nebraska		2	600	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(800)707-7051		(800)707-7051		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	005	0	1	01	01	H7149_005_0	5		1	07/14/2015	2016.01	07/14/2015 11:16:15 AM Central Daylight Time	08/02/2015 07:01:08 PM Central Daylight Time	07/29/2015 04:57:26 PM Central Daylight Time			08/02/2015 10:12:18 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Advantra Connect Plus (HMO)	01	01		1			H7149	005	0	2016	Partial State of Nebraska		2	500	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(855)893-1444		(855)893-1444		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	801	0	1	01	01	H7149_801_0	1		1	04/17/2015	2016.01	04/17/2015 12:48:02 PM Central Daylight Time	05/28/2015 08:23:01 AM Central Daylight Time				05/28/2015 10:42:49 AM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/NoRx/Cyear (HMO)	01	01		1			H7149	801	0	2016	Partial State of Nebraska		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H7149	802	0	1	01	01	H7149_802_0	1		1	04/17/2015	2016.01	04/17/2015 12:48:15 PM Central Daylight Time	05/28/2015 08:24:27 AM Central Daylight Time				05/28/2015 10:42:49 AM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/Rx/Cyear (HMO)	01	01		1			H7149	802	0	2016	Partial State of Nebraska		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)338-9551		(855)338-9551		(800)707-7051		(800)707-7051		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H7172	001	0	1	48	05	H7172_001_0	5		1	08/14/2015	2016.01	08/14/2015 08:12:22 PM Central Daylight Time					08/14/2015 08:14:58 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	2016	Ohio		2	13700	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)-		2					2					2				
H7173	001	0	1	01	01	H7173_001_0	6	2	1	08/12/2015	2016.01	08/12/2015 01:42:26 PM Central Daylight Time	08/03/2015 09:55:47 AM Pacific Daylight Time	07/30/2015 12:12:03 PM Pacific Daylight Time			08/12/2015 03:15:36 PM Pacific Daylight Time	PEACH STATE HEALTH PLAN, INC.	Peach State Health Plan	http://advantage.pshpgeorgia.com	Peach State Health Plan Advantage (HMO SNP)	01	01		1			H7173	001	0	2016	Metro Atlanta, North and Central Regions		2	358	2			1	3		1	2			http://advantage.pshpgeorgia.com/home/find-a-provider-or-pharmacy/	http://advantage.pshpgeorgia.com/home/prescription-drug-part-d-benefit-information/formulary/	http://advantage.pshpgeorgia.com/home/find-a-provider-or-pharmacy/	(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7187	003	0	1	01	01	H7187_003_0	3		1	07/31/2015	2016.01	07/31/2015 02:28:49 PM Central Daylight Time	07/31/2015 02:10:50 PM Central Daylight Time	07/30/2015 10:42:34 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H7187	003	0	2016	Richmond-Petersburg and Roanoke Metro areas		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7187	009	0	1	01	01	H7187_009_0	3		1	07/31/2015	2016.01	07/31/2015 02:29:42 PM Central Daylight Time	07/31/2015 02:11:15 PM Central Daylight Time	07/30/2015 10:42:52 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H7187	009	0	2016	Newport News, Norfolk and Portsmouth 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	2			
H7187	010	0	1	01	01	H7187_010_0	3		1	07/31/2015	2016.01	07/31/2015 02:30:41 PM Central Daylight Time	07/31/2015 02:11:40 PM Central Daylight Time	07/30/2015 10:43:11 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H7187	010	0	2016	Richmond-Petersburg and Roanoke Metro areas		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7187	011	0	1	01	01	H7187_011_0	3		1	07/31/2015	2016.01	07/31/2015 02:31:40 PM Central Daylight Time	07/31/2015 02:12:06 PM Central Daylight Time	07/30/2015 10:43:27 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H7187	011	0	2016	Newport News, Norfolk and Portsmouth 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	2			
H7195	001	0	1	20	08	H7195_001_0	2		1	06/09/2015	2016.01	06/09/2015 08:30:16 AM Central Daylight Time		05/22/2015 02:54:42 PM Central Daylight Time			06/09/2015 08:31:41 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	2016	Burleigh, Morton, and Stark Counties		2		2			2								n/a	http://www.pharmastarpbm.com/									(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	2		1	06/09/2015	2016.01	06/09/2015 08:30:29 AM Central Daylight Time		05/22/2015 02:54:42 PM Central Daylight Time			06/09/2015 08:31:41 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	2016	Burleigh, Morton, and Stark Counties		2		2			2								n/a	http://www.pharmastarpbm.com/									(888)883-8959		(701)751-3050		(888)883-8959		(701)751-3050										(888)838-8959		(701)751-3050		(888)838-8959		(701)751-3050																
H7200	006	0	1	01	01	H7200_006_0	7	2	1	07/31/2015	2016.01	07/31/2015 05:26:00 PM Eastern Daylight Time	08/01/2015 09:47:43 PM Eastern Daylight Time	07/30/2015 07:25:08 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Dual Coordination (HMO SNP)	01	01		1			H7200	006	0	2016	Select Counties in Tennessee		2	10735	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7200	007	0	1	01	01	H7200_007_0	8		1	07/31/2015	2016.01	07/31/2015 05:26:41 PM Eastern Daylight Time	08/01/2015 09:48:17 PM Eastern Daylight Time	07/30/2015 07:38:22 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H7200	007	0	2016	Select Counties in Tennessee		2	2370	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7200	013	0	1	01	01	H7200_013_0	7		1	07/06/2015	2016.01	07/06/2015 02:26:45 PM Eastern Daylight Time	08/01/2015 09:48:50 PM Eastern Daylight Time	07/30/2015 07:46:49 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic (HMO)	01	01		1			H7200	013	0	2016	Select Counties in Tennessee		2	145	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7220	002	0	1	01	01	H7220_002_0	9		1	07/08/2015	2016.01	07/08/2015 09:08:50 AM Eastern Daylight Time	07/08/2015 09:16:05 AM Eastern Daylight Time				07/08/2015 09:26:20 AM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	IU Health Plans Medicare Select (HMO)	01	01		1			H7220	002	0	2016	State of Indiana - 75 counties		2	1275	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(877)403-4178		(877)403-4178										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2					2	2			
H7220	003	0	1	01	01	H7220_003_0	12		1	07/08/2015	2016.01	07/08/2015 09:14:33 AM Eastern Daylight Time	08/03/2015 02:31:54 PM Eastern Daylight Time	07/29/2015 03:53:28 PM Eastern Daylight Time			08/04/2015 10:03:25 AM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	IU Health Plans Medicare Select Plus (HMO)	01	01		1			H7220	003	0	2016	State of Indiana - 75 counties		2	8409	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(877)403-4178		(877)403-4178		(866)823-1016		(866)823-1016		(877)403-4178		(877)403-4178		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7220	004	0	1	02	01	H7220_004_0	10		1	06/29/2015	2016.01	06/29/2015 04:57:17 PM Eastern Daylight Time	08/03/2015 02:31:54 PM Eastern Daylight Time	07/29/2015 03:55:56 PM Eastern Daylight Time			08/04/2015 10:03:25 AM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	IU Health Plans Medicare Choice (HMO-POS)	01	02		1			H7220	004	0	2016	State of Indiana - 75 counties		2	5846	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(877)403-4178		(877)403-4178		(866)823-1016		(866)823-1016		(877)403-4178		(877)403-4178		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7220	801	0	1	02	01	H7220_801_0	3		1	05/29/2015	2016.01	05/29/2015 03:28:48 PM Eastern Daylight Time	06/01/2015 05:22:43 PM Eastern Daylight Time				06/01/2015 05:26:44 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	Premiere Plus EGWP CY (HMO-POS)	01	02		1			H7220	801	0	2016	State of IN -  79 Counties		1	643	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(800)455-9776		(317)963-9700		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7220	802	0	1	02	01	H7220_802_0	3		1	05/29/2015	2016.01	05/29/2015 01:50:43 PM Eastern Daylight Time	06/01/2015 05:22:43 PM Eastern Daylight Time				06/01/2015 05:26:44 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	Premiere Plus EGWP NCY (HMO-POS)	01	02		1			H7220	802	0	2016	State of IN - 79 Counties		1	643	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(800)455-9776		(317)963-9700		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7220	804	0	1	01	01	H7220_804_0	3		1	05/29/2015	2016.01	05/29/2015 11:23:54 AM Eastern Daylight Time	06/01/2015 05:22:44 PM Eastern Daylight Time				06/01/2015 05:26:44 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	Premiere EGWP CY (HMO)	01	01		1			H7220	804	0	2016	State of IN - 79 Counties		1	643	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(800)455-9776		(317)963-9700		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7220	805	0	1	01	01	H7220_805_0	3		1	05/29/2015	2016.01	05/29/2015 01:51:46 PM Eastern Daylight Time	06/01/2015 05:22:44 PM Eastern Daylight Time				06/01/2015 05:26:44 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	Premiere EGWP NCY (HMO)	01	01		1			H7220	805	0	2016	State of IN- 79 Counties		1	643	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(800)455-9776		(317)963-9700		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H7245	001	0	1	01	01	H7245_001_0	6		1	07/31/2015	2016.01	07/31/2015 09:35:14 AM Pacific Daylight Time	08/03/2015 02:18:04 PM Pacific Daylight Time	07/30/2015 08:16:36 AM Pacific Daylight Time			08/04/2015 03:15:21 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	www.premera.com	Premera Blue Cross Medicare Advantage (HMO)	01	01		1			H7245	001	0	2016	King, Snohomish, Pierce, Thurston,Spokane counties		2		2			2							www.premera.com	www.premera.com	www.premera.com	(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	02	01	H7245_002_0	8		1	07/31/2015	2016.01	07/31/2015 09:47:21 AM Pacific Daylight Time	08/03/2015 02:24:56 PM Pacific Daylight Time	07/30/2015 08:17:34 AM Pacific Daylight Time			08/04/2015 03:17:17 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	www.premera.com	Premera Blue Cross Medicare Advantage (HMO-POS)	01	02		1			H7245	002	0	2016	King, Snohomish, Pierce, Thurston,Spokane counties		2		2			2							www.premera.com	www.premera.com	www.premera.com	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7245	003	0	1	01	01	H7245_003_0	6		1	07/21/2015	2016.01	07/21/2015 08:54:14 AM Pacific Daylight Time	08/03/2015 02:22:08 PM Pacific Daylight Time	07/30/2015 08:18:20 AM Pacific Daylight Time			08/04/2015 03:18:52 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	www.premera.com	Premera Blue Cross Medicare Advantage Plus (HMO)	01	01		1			H7245	003	0	2016	King, Snohomish, Pierce, Thurston,Spokane counties		2		2			2							www.premera.com	www.premera.com	www.premera.com	(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			
H7301	002	0	1	04	01	H7301_002_0	6		1	07/31/2015	2016.01	07/31/2015 07:32:15 PM Central Daylight Time	08/03/2015 10:39:38 AM Eastern Daylight Time	07/29/2015 05:57:45 PM Eastern Daylight Time			08/03/2015 11:10:12 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra (PPO)	01	04		1			H7301	002	0	2016	Central and Northern Illinois		2	373	2			2							www.providerdirectory.coventry-medicare.com	www.ilformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(800)707-9372		(800)707-9372		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	006	0	1	04	01	H7301_006_0	4		1	07/31/2015	2016.01	07/31/2015 07:34:18 PM Central Daylight Time	07/31/2015 06:32:17 PM Central Daylight Time	07/29/2015 04:58:04 PM Central Daylight Time			08/02/2015 11:13:39 PM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra Value (PPO)	01	04		1			H7301	006	0	2016	Illinois		2	1000	2			2							www.providerdirectory.coventry-medicare.com	www.ilformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(800)707-9372		(800)707-9372		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	007	0	1	04	01	H7301_007_0	7		1	07/31/2015	2016.01	07/31/2015 07:36:06 PM Central Daylight Time	08/04/2015 05:47:07 PM Eastern Daylight Time	07/29/2015 05:58:23 PM Eastern Daylight Time			08/04/2015 06:29:09 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra Value (PPO)	01	04		1			H7301	007	0	2016	Illinois		2	1000	2			2							www.providerdirectory.coventry-medicare.com	www.ilformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(800)707-9372		(800)707-9372		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	008	0	1	04	01	H7301_008_0	7		1	07/15/2015	2016.01	07/15/2015 12:32:09 PM Central Daylight Time	08/02/2015 06:12:55 PM Central Daylight Time	07/29/2015 04:58:42 PM Central Daylight Time			08/02/2015 11:13:39 PM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra Connect Plus (PPO)	01	04		1			H7301	008	0	2016	Northern and Central Illinois		2	500	2			2							www.providerdirectory.coventry-medicare.com	www.ilformulary.coventry-medicare.com	www.pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(800)707-9372		(800)707-9372		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	801	0	1	04	01	H7301_801_0	2		1	04/17/2015	2016.01	04/17/2015 12:48:28 PM Central Daylight Time	07/16/2015 04:30:15 PM Central Daylight Time				07/16/2015 05:07:49 PM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra MA Integrated Calendar (PPO)	01	04		1			H7301	801	0	2016	Central and Northern Illinois		1	0	2			2							www.providerdirectory.coventry-medicare.com	http://ilformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551		(800)707-9372		(800)707-9372		(855)338-9551		(855)338-9551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H7301	803	0	1	04	01	H7301_803_0	2		1	04/17/2015	2016.01	04/17/2015 11:38:11 AM Central Daylight Time	07/16/2015 04:30:15 PM Central Daylight Time				07/16/2015 05:07:49 PM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra MA Only (PPO)	01	04		1			H7301	803	0	2016	Central and Northern Illinois		1	0	2			2							www.providerdirectory.coventry-medicare.com	http://ilformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)338-9551		(855)338-9551										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1						2			
H7419	001	0	1	48	05	H7419_001_0	6		1	08/17/2015	2016.01	08/17/2015 02:39:44 PM Eastern Daylight Time					08/17/2015 02:53:06 PM Eastern Daylight Time	TUFTS HEALTH PUBLIC PLANS, INC.	Tufts Health Plan - Network Health	www.ChooseUnify.com	Tufts Health Unify (Medicare-Medicaid Plan)	05	48		1			H7419	001	0	2016	Worcester and Suffolk counties, Massachusetts		2	2250	2			2							www.TuftsHealthUnify.org	www.TuftsHealthUnify.org	www.TuftsHealthUnify.org	(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		2					2					2				
H7501	001	0	1	20	08	H7501_001_0	1		1	05/28/2015	2016.01	05/28/2015 04:57:42 PM Pacific Daylight Time		05/29/2015 06:55:49 AM Pacific Daylight Time			05/29/2015 05:41:51 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org	CalOptima PACE (PACE)	08	20		1			H7501	001	0	2016	Orange County		2		2			2								www.caloptima.org	www.caloptima.org/home/providers/pharmacy.aspx									(855)785-2584		(714)468-1100		(855)785-2584		(714)468-1100										(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929																
H7501	002	0	1	20	08	H7501_002_0	1		1	05/28/2015	2016.01	05/28/2015 04:58:43 PM Pacific Daylight Time		05/29/2015 06:57:12 AM Pacific Daylight Time			05/29/2015 05:41:51 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org	CalOptima PACE (PACE)	08	20		1			H7501	002	0	2016	Orange County		2		2			2								www.caloptima.org	www.caloptima.org/home/providers/pharmacy.aspx									(855)785-2584		(714)468-1100		(855)785-2584		(714)468-1100										(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929																
H7522	001	0	1	04	01	H7522_001_0	7		1	07/10/2015	2016.01	07/10/2015 07:21:48 PM SA Western Standard Time	08/05/2015 05:48:52 PM SA Western Standard Time	08/05/2015 05:48:52 PM SA Western Standard Time			08/05/2015 06:06:13 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmm-pr.com	First+Plus - Advantage Plus (PPO)	01	04		1			H7522	001	0	2016	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2						1	01	8a1;8b1;8b2;8b3;9a;9b;11a;11b1;11b2;11c1;11c2;12;	
H7522	801	0	1	04	01	H7522_801_0	5		1	07/08/2015	2016.01	07/08/2015 12:26:46 PM SA Western Standard Time	07/17/2015 12:02:16 PM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmm-pr.com	First+Plus - Advantage A Calendar (PPO)	01	04		1			H7522	801	0	2016	Puerto Rico		1		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9a;9b;9c;11a;11b;11c;	2		1						2			
H7522	802	0	1	04	01	H7522_802_0	5		1	07/08/2015	2016.01	07/08/2015 12:27:09 PM SA Western Standard Time	07/17/2015 11:57:06 AM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmm-pr.com	First+Plus - Advantage B Calendar (PPO)	01	04		1			H7522	802	0	2016	Puerto Rico		1		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9a;9b;9c;11a;11b;11c;	2		1						2			
H7522	803	0	1	04	01	H7522_803_0	5		1	07/08/2015	2016.01	07/08/2015 12:27:32 PM SA Western Standard Time	07/17/2015 11:52:58 AM SA Western Standard Time				07/17/2015 06:39:35 PM SA Western Standard Time	MMM HEALTHCARE, LLC	Medicare y Mucho Ms	www.mmm-pr.com	First+Plus - Advantage C Non Calendar (PPO)	01	04		1			H7522	803	0	2016	Puerto Rico		1		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9a;9b;9c;11a;11b;11c;	2		1						2			
H7542	001	0	1	48	05	H7542_001_0	10		1	08/27/2015	2016.01	08/27/2015 09:47:43 AM Central Daylight Time					08/27/2015 09:50:52 AM Central Daylight Time	ADVICARE, CORP.	Advicare Advocate	www.AdvicareHealth.com	Advicare, Corp. (Medicare-Medicaid Plan)	05	48		1			H7542	001	0	2016	South Carolina		2		2			2							www.AdvicareHealth.com	www.AdvicareHealth.com	www.AdvicareHealth.com	(844)564-0143		(864)263-0611		(844)564-0143		(864)263-0611		(844)564-0143		(864)263-0611		(844)564-0143		(864)263-0611		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		2					2					2				
H7660	001	0	1	20	08	H7660_001_0	1		1	05/22/2015	2016.01	05/22/2015 03:42:40 PM Eastern Daylight Time		05/21/2015 09:32:07 AM Eastern Daylight Time			05/22/2015 03:47:51 PM Eastern Daylight Time	VIECARE BEAVER LLC DBA LIFE BEAVER COUNTY	LIFE Beaver and Lawrence Counties	http://www.lutheranseniorlife.org	VieCare Beaver, LLC (PACE)	08	20		1			H7660	001	0	2016	LIFE Beaver and Lawrence Counties		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(724)378-5400		(724)742-2226		(724)378-5400		(724)378-5400										(724)378-5400		(724)378-5400		(724)378-5400		(724)378-5400																
H7660	002	0	1	20	08	H7660_002_0	1		1	05/22/2015	2016.01	05/22/2015 03:43:10 PM Eastern Daylight Time		05/21/2015 09:36:27 AM Eastern Daylight Time			05/22/2015 03:47:51 PM Eastern Daylight Time	VIECARE BEAVER LLC DBA LIFE BEAVER COUNTY	LIFE Beaver and Lawrence Counties	www.LutheranSeniorLife.org	VieCare Beaver, LLC (PACE)	08	20		1			H7660	002	0	2016	LIFE Beaver and Lawrence Counties		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(724)378-5400		(724)378-5400		(724)378-5400		(724)378-5400										(724)378-5400		(724)378-5400		(724)378-5400		(724)378-5400																
H7678	001	0	1	01	01	H7678_001_0	6	2	1	08/05/2015	2016.01	08/05/2015 03:29:16 PM Pacific Daylight Time	08/04/2015 01:50:30 PM Pacific Daylight Time	07/30/2015 09:01:40 AM Pacific Daylight Time			08/05/2015 04:11:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF TEXAS, INC.	Molina Healthcare of Texas, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H7678	001	0	2016	West, North, and Southern Texas		2		2			1	3		1	5			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	10		1	07/10/2015	2016.01	07/10/2015 10:35:29 AM Mountain Daylight Time	07/30/2015 12:50:40 PM Mountain Daylight Time	07/30/2015 12:26:37 PM Mountain Daylight Time			08/05/2015 09:03:48 AM Mountain Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.Prominencehealthplan.com/medicare	Prominence Plus (HMO)	01	01		1			H7680	001	0	2016	North Texas		2	969	1	1		2							www.Prominencehealthplan.com/medicare	www.Prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(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	7		1	07/10/2015	2016.01	07/10/2015 10:36:11 AM Mountain Daylight Time	07/30/2015 12:51:27 PM Mountain Daylight Time	07/30/2015 12:27:41 PM Mountain Daylight Time			08/05/2015 09:03:48 AM Mountain Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.Prominencehealthplan.com/medicare	Prominence Plus (HMO)	01	01		1			H7680	002	0	2016	South Texas		2	1382	1	1		2							www.Prominencehealthplan.com/medicare	www.Prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	801	0	1	01	01	H7680_801_0	4		1	05/29/2015	2016.01	05/29/2015 12:00:18 PM Mountain Daylight Time	05/29/2015 10:57:05 AM Mountain Daylight Time				05/30/2015 04:17:20 PM Mountain Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.Prominencehealthplan.com/medicare	Prominence Health Plan (HMO)	01	01		1			H7680	801	0	2016	National		1	1	1	1		2							www.Prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;9d;10a;11a;11b;12;15;16b;	2		1					1	2			
H7680	802	0	1	01	01	H7680_802_0	4		1	05/29/2015	2016.01	05/29/2015 12:00:29 PM Mountain Daylight Time	05/29/2015 10:57:47 AM Mountain Daylight Time				05/30/2015 04:17:20 PM Mountain Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.Prominencehealthplan.com/medicare	Prominence Health Plan (HMO)	01	01		1			H7680	802	0	2016	National		1	1	1	1		2							www.Prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;9d;10a;11a;11b;12;15;16b;	2		1					1	2			
H7680	803	0	1	01	01	H7680_803_0	4		1	05/29/2015	2016.01	05/29/2015 12:00:38 PM Mountain Daylight Time	05/29/2015 10:58:34 AM Mountain Daylight Time				05/30/2015 04:17:20 PM Mountain Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.Prominencehealthplan.com/medicare	Prominence Health Plan (HMO)	01	01		1			H7680	803	0	2016	National		1	1	1	1		2							www.Prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;9d;10a;11a;11b;12;15;16b;	2		1					1	2			
H7680	804	0	1	01	01	H7680_804_0	4		1	05/29/2015	2016.01	05/29/2015 12:00:49 PM Mountain Daylight Time	05/29/2015 10:59:16 AM Mountain Daylight Time				05/30/2015 04:17:20 PM Mountain Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.Prominencehealthplan.com/medicare	Prominence Health Plan (HMO)	01	01		1			H7680	804	0	2016	National		1	1	1	1		2							www.Prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;9d;10a;11a;11b;12;15;16b;	2		1					1	2			
H7680	805	0	1	01	01	H7680_805_0	4		1	05/29/2015	2016.01	05/29/2015 12:00:57 PM Mountain Daylight Time	05/29/2015 11:00:00 AM Mountain Daylight Time				05/30/2015 04:17:20 PM Mountain Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.Prominencehealthplan.com/medicare	Prominence Health Plan (HMO)	01	01		1			H7680	805	0	2016	National		1	1	1	1		2							www.Prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;9d;10a;11a;11b;12;15;16b;	2		1					1	2			
H7680	806	0	1	01	01	H7680_806_0	5		1	05/29/2015	2016.01	05/29/2015 12:01:06 PM Mountain Daylight Time	05/29/2015 11:00:45 AM Mountain Daylight Time				05/30/2015 10:25:05 PM Mountain Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.Prominencehealthplan.com/medicare	Prominence Health Plan (HMO)	01	01		1			H7680	806	0	2016	National		1	1	1	1		2							www.Prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	www.prominencehealthplan.com/medicare	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7g;7h;7i;8a;8b1;8b2;9a;9b;9c;9d;10a;11a;11b;12;15;16b;	2		1					1	2			
H7728	002	0	1	04	01	H7728_002_0	9		1	07/31/2015	2016.01	07/31/2015 01:39:58 PM Eastern Daylight Time	08/01/2015 09:49:22 PM Eastern Daylight Time	07/30/2015 06:38:17 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	01	04		1			H7728	002	0	2016	Select Counties in New Hampshire		2	611	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)304-1787		(855)304-1787		(844)368-4245		(844)368-4245		(855)304-1787		(855)304-1787		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	801	0	1	04	01	H7728_801_0	4		1	05/29/2015	2016.01	05/29/2015 12:33:10 PM Pacific Daylight Time	05/31/2015 09:39:09 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	2016	New Hampshire		1	903	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647		(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H7728	802	0	1	04	01	H7728_802_0	4		1	05/29/2015	2016.01	05/29/2015 12:34:23 PM Pacific Daylight Time	05/31/2015 01:17:49 AM Pacific Daylight Time				05/31/2015 08:05:48 PM 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	2016	New Hampshire		1	50	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H7728	803	0	1	04	01	H7728_803_0	4		1	05/29/2015	2016.01	05/29/2015 12:35:21 PM Pacific Daylight Time	05/31/2015 01:17:54 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	803	0	2016	New Hampshire		1	50	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647		(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H7787	001	0	1	04	01	H7787_001_0	5		1	07/21/2015	2016.01	07/21/2015 10:27:03 AM Central Daylight Time	07/31/2015 09:12:14 AM Central Daylight Time	07/30/2015 08:33:42 AM Central Daylight Time			08/03/2015 09:24:52 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (PPO)	01	04		1			H7787	001	0	2016	North Texas		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7787	002	0	1	04	01	H7787_002_0	5		1	07/22/2015	2016.01	07/22/2015 10:42:51 AM Central Daylight Time	07/12/2015 10:02:47 AM Central Daylight Time				07/22/2015 02:43:34 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (PPO)	01	04		1			H7787	002	0	2016	North Texas		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7833	001	0	1	48	05	H7833_001_0	5		1	08/31/2015	2016.01	08/31/2015 11:35:27 AM Central Daylight Time					08/31/2015 11:38:04 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	www.UHCCommunityplan.com	UnitedHealthcare Connected (Medicare-Medicaid Plan)	05	48		1			H7833	001	0	2016	UnitedHealthcare Community Plan MMP Plan Regions		2		2			2							www.UHCCommunityplan.com	www.UHCCommunityplan.com	www.optumrx.com			(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)-		2					2					2				
H7844	001	0	1	48	05	H7844_001_0	5		1	08/26/2015	2016.01	08/26/2015 02:06:20 PM Pacific Daylight Time					08/26/2015 02:42:27 PM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H7844	001	0	2016	Wayne and Macomb County		2		2			2							www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)735-5604		(855)735-5604		(855)701-4885		(855)701-4885		(855)735-5604		(855)735-5604		(855)701-4885		(855)701-4885		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H7855	001	0	1	20	08	H7855_001_0	1		1	05/26/2015	2016.01	05/26/2015 09:17:42 AM Pacific Daylight Time		05/18/2015 01:45:26 PM Pacific Daylight Time			05/26/2015 09:19:41 AM Pacific Daylight Time	LOS ANGELES JEWISH HOME FOR THE AGING	Brandman Centers for Senior Care	www.brandmanseniorcare.org	Brandman Centers for Senior Care-Dual (PACE)	08	20		1			H7855	001	0	2016	Brandman Centers for Senior Care-Dual		2		2			2								Not applicable	www.carekinesis.com									(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	2		1	05/26/2015	2016.01	05/26/2015 09:28:13 AM Pacific Daylight Time		05/18/2015 01:46:32 PM Pacific Daylight Time			05/26/2015 09:28:27 AM Pacific Daylight Time	LOS ANGELES JEWISH HOME FOR THE AGING	Brandman Centers for Senior Care	www.brandmanseniorcare.org	Brandman Centers for Senior Care-Medicare Only (PACE)	08	20		1			H7855	002	0	2016	Brandman Centers for Senior Care-Medicare Only		2		2			2								Not applicable	www.carekinesis.com									(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																
H7885	001	0	1	48	05	H7885_001_0	4		1	07/15/2015	2016.01	07/15/2015 12:37:00 PM Pacific Daylight Time					07/15/2015 12:40:00 PM Pacific Daylight Time	SAN MATEO HEALTH COMMISSION	Health Plan of San Mateo	www.hpsm.org	CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H7885	001	0	2016	San Mateo County		2	11000	2			2							www.hpsm.org	http://www.hpsm.org/members/careadvantage-2012/drug-coverage.aspx	http://www.hpsm.org/providers/provider-resources/pharmacy.aspx	(866)880-0606		(650)616-2174		(888)252-3153		(650)616-1500		(866)880-0606		(650)616-2174		(888)252-3153		(650)616-1500		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2				
H7890	001	0	1	48	05	H7890_001_0	4		1	07/14/2015	2016.01	07/14/2015 02:44:21 PM Pacific Daylight Time					07/16/2015 09:51:27 AM Pacific Daylight Time	SANTA CLARA COUNTY HEALTH AUTHORITY	Santa Clara Family Health Plan Cal MediConnect	www.scfhp.com	Santa Clara Family Health Plan (Medicare-Medicaid Plan)	05	48		1			H7890	001	0	2016	Santa Clara County		2	400	2			2							www.scfhp.com/healthcareplans/calmediconnect	www.scfhp.com/healthcareplans/calmediconnect	www.scfhp.com/healthcareplans/calmediconnect	(877)723-4795		(408)376-2000		(877)723-4795		(408)376-2000		(877)723-4795		(408)376-2000		(877)723-4795		(408)376-2000		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2				
H7903	001	0	1	01	01	H7903_001_0	5		1	07/13/2015	2016.01	07/13/2015 08:35:45 AM Central Daylight Time	07/29/2015 04:16:28 PM Central Daylight Time	07/29/2015 02:08:08 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	CLEARRIVER HEALTH	ClearRiver Health	www.clearriverhealth.com	Classic Plus Rx (HMO)	01	01		1			H7903	001	0	2016	Greater Chattanooga Metropolitan Area		2	728	2			2							www.clearriverhealth.com	www.clearriverhealth.com	www.clearriverhealth.com	(877)512-3176		(253)345-5549		(877)512-3176		(253)345-5549		(877)512-3176		(253)345-5549		(877)512-3176		(253)345-5549		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7917	008	0	1	04	01	H7917_008_0	4		1	09/17/2015	2016.01	09/17/2015 01:18:16 PM Eastern Daylight Time	08/05/2015 08:26:46 AM Eastern Daylight Time	08/05/2015 08:26:47 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	008	0	2016	West Tennessee		2	418	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	009	0	1	04	01	H7917_009_0	4		1	09/17/2015	2016.01	09/17/2015 01:19:24 PM Eastern Daylight Time	08/05/2015 08:26:47 AM Eastern Daylight Time	08/05/2015 08:26:47 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	009	0	2016	Middle Tennessee		2	1361	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	4		1	09/17/2015	2016.01	09/17/2015 01:21:00 PM Eastern Daylight Time	08/05/2015 08:26:48 AM Eastern Daylight Time	08/05/2015 08:26:48 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	010	0	2016	Southeast Tennessee		2	1460	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	5		1	09/17/2015	2016.01	09/17/2015 01:22:29 PM Eastern Daylight Time	08/05/2015 08:26:48 AM Eastern Daylight Time	08/05/2015 08:26:48 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	011	0	2016	Northeast Tennessee		2	3736	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	6		1	09/17/2015	2016.01	09/17/2015 01:27:16 PM Eastern Daylight Time	08/05/2015 08:26:49 AM Eastern Daylight Time	08/05/2015 08:26:49 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	012	0	2016	West Tennessee		2	1111	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	09/17/2015	2016.01	09/17/2015 01:28:15 PM Eastern Daylight Time	08/05/2015 08:26:49 AM Eastern Daylight Time	08/05/2015 08:26:49 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	013	0	2016	Middle Tennessee		2	2300	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	5		1	09/17/2015	2016.01	09/17/2015 01:29:24 PM Eastern Daylight Time	08/05/2015 08:26:50 AM Eastern Daylight Time	08/05/2015 08:26:50 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	014	0	2016	Southeast Tennessee		2	6106	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	4		1	09/17/2015	2016.01	09/17/2015 01:30:55 PM Eastern Daylight Time	08/05/2015 08:26:50 AM Eastern Daylight Time	08/05/2015 08:26:51 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	015	0	2016	Northeast Tennessee		2	2316	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	09/17/2015	2016.01	09/17/2015 01:31:51 PM Eastern Daylight Time	08/05/2015 08:26:36 AM Eastern Daylight Time	08/05/2015 08:26:36 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	030	0	2016	Southeast Tennessee		2	27879	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	5		1	09/17/2015	2016.01	09/17/2015 01:32:49 PM Eastern Daylight Time	08/05/2015 08:26:36 AM Eastern Daylight Time	08/05/2015 08:26:37 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	031	0	2016	Northeast Tennessee		2	7117	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	5		1	09/17/2015	2016.01	09/17/2015 01:35:22 PM Eastern Daylight Time	08/05/2015 08:26:37 AM Eastern Daylight Time	08/05/2015 08:26:37 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	032	0	2016	Middle Tennessee		2	30818	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	5		1	09/17/2015	2016.01	09/17/2015 01:36:30 PM Eastern Daylight Time	08/05/2015 08:26:37 AM Eastern Daylight Time	08/05/2015 08:26:38 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	033	0	2016	West Tennessee		2	13065	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.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	05/30/2015	2016.01	05/30/2015 10:26:31 AM Eastern Daylight Time	06/01/2015 02:04:09 AM Eastern Daylight Time				06/01/2015 12:59:28 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	801	0	2016	22 County Region		1	2000	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(888)476-5072		(888)476-5072		(800)831-2583		(800)831-2583		(888)476-5072		(888)476-5072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9b;11a;15;	2		1						2			
H7917	802	0	1	04	01	H7917_802_0	1		1	05/30/2015	2016.01	05/30/2015 10:26:44 AM Eastern Daylight Time	06/01/2015 02:04:10 AM Eastern Daylight Time				06/01/2015 12:59:28 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	802	0	2016	22 County Region		1	600	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(888)476-5072		(888)476-5072		(800)831-2583		(800)831-2583		(888)476-5072		(888)476-5072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9b;11a;15;	2		1						2			
H7917	803	0	1	04	01	H7917_803_0	1		1	05/30/2015	2016.01	05/30/2015 10:27:06 AM Eastern Daylight Time	06/01/2015 02:04:10 AM Eastern Daylight Time				06/01/2015 12:59:28 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage (PPO)	01	04		1			H7917	803	0	2016	22 County Region		1	200	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7i;8b1;8b2;9b;11a;15;	2		1						2			
H7960	001	0	1	01	01	H7960_001_0	8		1	08/05/2015	2016.01	08/05/2015 11:53:02 AM US Mountain Standard Time	08/05/2015 03:46:08 PM US Mountain Standard Time	08/05/2015 03:46:29 PM US Mountain Standard Time			08/05/2015 03:49:15 PM US Mountain Standard Time	HARBOR HEALTH PLAN, INC.	Harbor Advantage	www.harborhealthadvantage.com	Harbor Advantage (HMO)	01	01		1			H7960	001	0	2016	Wayne County		2	600	2			2							www.harborhealthadvantage.com	www.harborhealthadvantage.com	www.harborhealthadvantage.com	(855)343-9243		(313)833-7645		(855)343-9244		(313)833-7648		(855)343-9243		(313)833-7645		(855)343-9244		(313)833-7648		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7960	002	0	1	01	01	H7960_002_0	7		1	08/05/2015	2016.01	08/05/2015 12:00:49 PM US Mountain Standard Time	08/05/2015 03:46:51 PM US Mountain Standard Time	08/05/2015 03:47:00 PM US Mountain Standard Time			08/05/2015 03:58:33 PM US Mountain Standard Time	HARBOR HEALTH PLAN, INC.	Harbor Advantage	www.harborhealthadvantage.com	Harbor Advantage Select (HMO)	01	01		1			H7960	002	0	2016	Wayne County		2	600	2			2							www.harborhealthadvantage.com	www.harborhealthadvantage.com	www.harborhealthadvantage.com/members/prescription-drug-information	(855)343-9243		(313)833-7645		(855)343-9244		(313)833-7648		(855)343-9243		(313)833-7645		(855)343-9244		(313)833-7648		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7971	001	0	1	04	01	H7971_001_0	10		1	07/06/2015	2016.01	07/06/2015 10:15:16 AM Eastern Daylight Time	08/03/2015 01:15:37 PM Eastern Daylight Time	08/03/2015 01:14:31 PM Eastern Daylight Time			08/03/2015 01:48:30 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue (PPO)	01	04		1			H7971	001	0	2016	Sussex County		2	10	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2						2			
H7971	801	0	1	04	01	H7971_801_0	7		1	07/06/2015	2016.01	07/06/2015 10:15:26 AM Eastern Daylight Time	07/01/2015 01:16:49 PM Eastern Daylight Time				07/06/2015 02:43:35 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group (PPO)	01	04		1			H7971	801	0	2016	National		1	42	2			2							http://directory.horizonblue.com/	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142										(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899										2					2						2			
H7971	802	0	1	04	01	H7971_802_0	6		1	07/06/2015	2016.01	07/06/2015 10:17:25 AM Eastern Daylight Time	07/01/2015 01:17:57 PM Eastern Daylight Time				07/06/2015 02:43:35 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group w/rx (PPO)	01	04		1			H7971	802	0	2016	National		1	180	2			2							http://directory.horizonblue.com/	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en/find-medicine.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en.html	(800)365-2223		(800)365-2223		(888)765-7142		(888)765-7142		(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2						2			
H8016	001	0	1	48	05	H8016_001_0	2		1	06/23/2015	2016.01	06/23/2015 08:35:38 PM Pacific Daylight Time					06/23/2015 08:47:32 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima	www.caloptima.org/OneCareConnect	OneCare Connect (Medicare-Medicaid Plan)	05	48		1			H8016	001	0	2016	Orange County, CA		2		2			2							www.caloptima.org	www.caloptima.org	http://www.caloptima.org/Home/Providers/Pharmacy.aspx	(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2				
H8026	001	0	1	48	05	H8026_001_0	12		1	07/23/2015	2016.01	07/23/2015 06:48:42 PM Eastern Daylight Time					07/23/2015 06:50:37 PM Eastern 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	2016	Wayne, Macomb and Southwest Michigan Regions		2	10000	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)-		2					2					2				
H8029	001	0	1	48	05	H8029_001_0	9		1	08/25/2015	2016.01	08/25/2015 03:13:34 PM Eastern Daylight Time					08/25/2015 04:23:05 PM Eastern Daylight Time	ELDERPLAN, INC.	Edlerplan FIDA Total Care	www.elderplan.org	Elderplan FIDA Total Care (Medicare-Medicaid Plan)	05	48		1			H8029	001	0	2016	Ki, Qu, Brx, NY, Ri, Wes, Suf, and Na		2	100	2			2							www.elderplan.org	www.elderplan.org	www.envisionrx.com	(855)462-3167		(718)921-7979		(866)695-8101		(866)695-8101		(844)860-6749		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H8046	001	0	1	48	05	H8046_001_0	5		1	08/17/2015	2016.01	08/17/2015 09:03:21 AM Pacific Daylight Time					08/17/2015 09:40:21 AM Pacific Daylight Time	MOLINA HEALTHCARE OF ILLINOIS, INC.	Molina Healthcare of Illinois	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8046	001	0	2016	Central 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)-		2					2					2				
H8056	001	0	1	48	05	H8056_001_0	8		1	08/25/2015	2016.01	08/25/2015 02:09:27 PM Central Daylight Time					08/25/2015 02:21:21 PM Central Daylight Time	AETNA BETTER HEALTH, INC. (NY)	Aetna Better Health FIDA Plan	www.aetnabetterhealth.com/newyork	Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H8056	001	0	2016	Kings, Queens, New York, Suffolk and Nassau		2	842	2			2							www.aetnabetterhealth.com/newyork	www.aetnabetterhealth.com/newyork	www.aetnabetterhealth.com/newyork	(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H8064	002	0	1	04	01	H8064_002_0	9		1	07/14/2015	2016.01	07/14/2015 03:14:33 PM Pacific Daylight Time	07/31/2015 03:16:37 PM Pacific Daylight Time	07/31/2015 03:16:39 PM Pacific Daylight Time			07/31/2015 03:51:05 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstCarolinaCare Insurance Company	www.firstmedicare.com	FirstMedicare Direct PPO Plus (PPO)	01	04		1			H8064	002	0	2016	South Central North Carolina		2	1300	2			2							www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8067	001	0	1	01	01	H8067_001_0	6		1	08/05/2015	2016.01	08/05/2015 01:40:53 PM Central Daylight Time	08/05/2015 12:10:57 PM Central Daylight Time	08/05/2015 12:10:55 PM Central Daylight Time			08/05/2015 01:42:44 PM Central Daylight Time	PROVIDER PARTNERS HEALTH PLAN	Provider Partners Advantage	pphealthplan.com	Provider Partners Advantage (HMO SNP)	01	01		1			H8067	001	0	2016	Western & Central Maryland		2	189	2			1	1	1	1				pphealthplan.com	pphealthplan.com	pphealthplan.com	(800)504-9681		(800)504-9681		(800)504-9681		(800)504-9681		(800)504-9681		(800)504-9681		(800)504-9681		(800)504-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8091	002	0	1	04	01	H8091_002_0	9		1	07/09/2015	2016.01	07/09/2015 12:50:01 PM Central Daylight Time	08/04/2015 02:47:18 PM Central Daylight Time	08/04/2015 02:47:19 PM Central Daylight Time			08/04/2015 02:54:34 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	Medi-Pak Advantage Elite (PPO)	01	04		1			H8091	002	0	2016	Craighead, Cross, Greene, Lawrence and Poinsett		2	429	2			2							www.arkansasbluecross.com/providers/MedipakAdvantage.aspx	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)401-8808		(877)401-8808		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8091	004	0	1	04	01	H8091_004_0	8		1	07/09/2015	2016.01	07/09/2015 12:50:26 PM Central Daylight Time	08/04/2015 02:47:20 PM Central Daylight Time	08/04/2015 02:47:20 PM Central Daylight Time			08/04/2015 02:54:34 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	Medi-Pak Advantage Essential (PPO)	01	04		1			H8091	004	0	2016	Craighead, Cross, Greene, Lawrence and Poinsett		2	831	2			2							www.arkansasbluecross.com/providers/MedipakAdvantage.aspx	www.abcbs.com	http://www.arkansasbluecross.com	(877)401-8808		(877)401-8808		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8096	001	0	1	20	08	H8096_001_0	1		1	05/21/2015	2016.01	05/21/2015 11:59:15 AM Eastern Daylight Time		05/21/2015 09:11:13 AM Eastern Daylight Time			05/21/2015 12:01:05 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrahealth.com/pace-program	Centra PACE - Dual (PACE)	08	20		1			H8096	001	0	2016	Centra PACE - Lynchburg		2		2			2								http:\\www.centrahealth.com	www.centrahealth.com									(888)316-9540		(434)200-6516		(888)316-9540		(434)200-6516										(800)828-1140		(800)828-1140		(800)828-1140		(800)828-1140																
H8096	002	0	1	20	08	H8096_002_0	1		1	05/21/2015	2016.01	05/21/2015 11:59:41 AM Eastern Daylight Time		05/21/2015 09:12:07 AM Eastern Daylight Time			05/21/2015 12:01:05 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrahealth.com/pace-program	Centra PACE - Medicare only (PACE)	08	20		1			H8096	002	0	2016	Centra PACE - Lynchburg		2		2			2								http:\\www.centrahealth.com	www.centrahealth.com									(888)316-9540		(434)200-6516		(888)316-9540		(434)200-6516										(800)828-1140		(800)828-1140		(800)828-1140		(800)828-1140																
H8130	001	0	1	01	01	H8130_001_0	7	2	1	08/05/2015	2016.01	08/05/2015 03:29:27 PM Pacific Daylight Time	08/04/2015 04:14:54 PM Pacific Daylight Time	07/30/2015 09:01:52 AM Pacific Daylight Time			08/05/2015 04:11:36 PM Pacific Daylight Time	MOLINA HEALTHCARE OF FLORIDA, INC.	Molina Healthcare of Florida	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H8130	001	0	2016	Panhandle, NE Florida, Tampa, and Central Florida		2		2			1	3		1	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	6		1	07/16/2015	2016.01	07/16/2015 12:56:31 PM Central Daylight Time	08/03/2015 03:37:04 PM Central Daylight Time	08/03/2015 02:26:58 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	001	0	2016	Houston Metro Area		2		2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	003	0	1	01	01	H8133_003_0	9		1	07/15/2015	2016.01	07/15/2015 05:03:09 PM Central Daylight Time	08/03/2015 03:37:40 PM Central Daylight Time	08/03/2015 02:28:04 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	003	0	2016	El Paso		2	6011	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	004	0	1	01	01	H8133_004_0	10		1	07/15/2015	2016.01	07/15/2015 05:04:47 PM Central Daylight Time	08/03/2015 03:38:16 PM Central Daylight Time	08/03/2015 02:29:40 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Premier (HMO)	01	01		1			H8133	004	0	2016	El Paso		2	6011	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	005	0	1	01	01	H8133_005_0	9		1	07/15/2015	2016.01	07/15/2015 05:07:36 PM Central Daylight Time	08/03/2015 03:38:52 PM Central Daylight Time	08/03/2015 02:47:48 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	005	0	2016	South Texas		2	6011	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	006	0	1	01	01	H8133_006_0	11		1	07/15/2015	2016.01	07/15/2015 05:09:34 PM Central Daylight Time	08/03/2015 03:39:28 PM Central Daylight Time	08/03/2015 02:46:38 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Premier (HMO)	01	01		1			H8133	006	0	2016	South Texas		2	6011	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	007	0	1	01	01	H8133_007_0	16		1	07/15/2015	2016.01	07/15/2015 05:10:43 PM Central Daylight Time	08/03/2015 03:40:02 PM Central Daylight Time	08/03/2015 02:57:52 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	007	0	2016	Austin		2	6011	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	008	0	1	01	01	H8133_008_0	10		1	07/15/2015	2016.01	07/15/2015 05:12:00 PM Central Daylight Time	08/03/2015 03:40:38 PM Central Daylight Time	08/03/2015 02:44:54 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Premier (HMO)	01	01		1			H8133	008	0	2016	Austin		2	6011	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	009	0	1	01	01	H8133_009_0	6	2	1	08/04/2015	2016.01	08/04/2015 10:22:22 AM Central Daylight Time	08/03/2015 03:41:14 PM Central Daylight Time	08/03/2015 02:44:02 PM Central Daylight Time			08/04/2015 02:36:03 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage Dual Care (HMO SNP)	01	01		1			H8133	009	0	2016	Bastrp,Burnet,Caldwl,Hays,Lee,Wilmson&El Paso ctys		2	15	2			1	3		1	4			www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)895-6437		(877)895-6437		(877)727-4084		(877)727-4084		(877)895-6437		(877)895-6437		(877)727-4084		(877)727-4084		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	011	0	1	01	01	H8133_011_0	7		1	07/16/2015	2016.01	07/16/2015 12:58:34 PM Central Daylight Time	08/03/2015 03:41:48 PM Central Daylight Time	08/03/2015 02:54:06 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.hcsc.com	Blue Cross Medicare Advantage Premier (HMO)	01	01		1			H8133	011	0	2016	Houston Metro Area		2		2			2								https://myprime.com	www.yourpartd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8133	801	0	1	01	01	H8133_801_0	5		1	05/29/2015	2016.01	05/29/2015 09:41:07 AM Central Daylight Time	07/16/2015 12:30:44 PM Central Daylight Time				07/16/2015 02:26:15 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H8133	801	0	2016	Houston		1	5663	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H8133	803	0	1	01	01	H8133_803_0	6		1	05/01/2015	2016.01	05/20/2015 04:34:35 PM Central Daylight Time	07/16/2015 05:02:40 PM Central Daylight Time				07/16/2015 05:06:06 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H8133	803	0	2016	Houston		1	5663	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H8133	805	0	1	01	01	H8133_805_0	5		1	05/01/2015	2016.01	05/20/2015 04:34:46 PM Central Daylight Time	07/16/2015 12:28:09 PM Central Daylight Time				07/16/2015 02:26:15 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H8133	805	0	2016	Houston		1	5663	2			2							www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;8a;11a;11b;	2		1					1	2			
H8145	003	0	1	09	04	H8145_003_0	4		1	07/20/2015	2016.01	07/20/2015 04:19:30 PM Eastern Daylight Time	08/01/2015 01:20:15 PM Eastern Daylight Time	07/30/2015 12:37:08 AM Eastern Daylight Time			08/04/2015 01:52:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-003 (PFFS)	04	09	1	1			H8145	003	0	2016	Select Counties in Virginia		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	004	0	1	09	04	H8145_004_0	3		1	07/09/2015	2016.01	07/09/2015 03:43:56 PM Eastern Daylight Time	07/31/2015 06:03:15 PM Eastern Daylight Time	07/30/2015 12:37:42 AM Eastern Daylight Time			08/04/2015 01:52:47 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-004 (PFFS)	04	09	1	1			H8145	004	0	2016	Select counties in Virginia		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 01:32:06 PM Eastern Daylight Time	08/04/2015 11:56:33 AM Eastern Daylight Time	07/30/2015 12:38:18 AM Eastern Daylight Time			08/04/2015 01:18:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-006 (PFFS)	04	09	1	1			H8145	006	0	2016	Select Counties in Michigan and Wisconsin		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 03:22:04 PM Eastern Daylight Time	08/04/2015 11:16:01 AM Eastern Daylight Time	07/30/2015 12:38:54 AM Eastern Daylight Time			08/04/2015 01:11:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-008 (PFFS)	04	09	1	1			H8145	008	0	2016	Select Counties in Illinois		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	011	0	1	09	04	H8145_011_0	4		1	07/20/2015	2016.01	07/20/2015 01:34:24 PM Eastern Daylight Time	07/31/2015 05:48:47 PM Eastern Daylight Time	07/30/2015 12:39:30 AM Eastern Daylight Time			08/04/2015 02:24:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-011 (PFFS)	04	09	1	1			H8145	011	0	2016	Select Counties in Indiana		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	020	0	1	09	04	H8145_020_0	3		1	07/09/2015	2016.01	07/09/2015 03:44:37 PM Eastern Daylight Time	07/31/2015 05:16:18 PM Eastern Daylight Time	07/30/2015 12:40:04 AM Eastern Daylight Time			08/04/2015 01:55:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-020 (PFFS)	04	09	1	1			H8145	020	0	2016	Select Counties in Kentucky		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	021	0	1	09	04	H8145_021_0	4		1	07/08/2015	2016.01	07/08/2015 03:54:36 PM Eastern Daylight Time	07/31/2015 05:16:39 PM Eastern Daylight Time	07/30/2015 12:40:40 AM Eastern Daylight Time			08/04/2015 01:55:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-021 (PFFS)	04	09	1	1			H8145	021	0	2016	Select Counties in Kentucky and West Virginia		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	032	0	1	09	04	H8145_032_0	4		1	07/08/2015	2016.01	07/08/2015 02:05:21 PM Eastern Daylight Time	07/31/2015 05:56:07 PM Eastern Daylight Time	07/30/2015 12:41:16 AM Eastern Daylight Time			08/04/2015 02:24:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-032 (PFFS)	04	09	1	1			H8145	032	0	2016	Select Counties in Ohio		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/09/2015	2016.01	07/09/2015 03:45:17 PM Eastern Daylight Time	05/24/2015 07:20:38 PM Eastern Daylight Time				07/10/2015 12:18:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-042 (PFFS)	04	09	1	1			H8145	042	0	2016	Select Counties in Virginia		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	050	0	1	09	04	H8145_050_0	2		1	07/09/2015	2016.01	07/09/2015 03:45:55 PM Eastern Daylight Time	05/26/2015 11:28:10 AM Eastern Daylight Time				07/10/2015 12:18:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-050 (PFFS)	04	09	1	1			H8145	050	0	2016	Select Counties in West Virginia		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	051	0	1	09	04	H8145_051_0	3		1	07/09/2015	2016.01	07/09/2015 03:46:36 PM Eastern Daylight Time	07/31/2015 05:15:37 PM Eastern Daylight Time	07/30/2015 12:41:50 AM Eastern Daylight Time			08/04/2015 01:55:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-051 (PFFS)	04	09	1	1			H8145	051	0	2016	Select Counties in West Virginia		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	052	0	1	09	04	H8145_052_0	4		1	07/21/2015	2016.01	07/21/2015 10:01:05 AM Eastern Daylight Time	07/31/2015 06:00:59 PM Eastern Daylight Time	07/30/2015 12:42:26 AM Eastern Daylight Time			08/04/2015 01:55:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-052 (PFFS)	04	09	1	1			H8145	052	0	2016	Select Counties in Pennsylvania		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	053	0	1	09	04	H8145_053_0	3		1	07/09/2015	2016.01	07/09/2015 03:47:45 PM Eastern Daylight Time	07/31/2015 06:01:33 PM Eastern Daylight Time	07/30/2015 12:43:02 AM Eastern Daylight Time			08/04/2015 01:55:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-053 (PFFS)	04	09	1	1			H8145	053	0	2016	Select Counties in Pennsylvania		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/09/2015	2016.01	07/09/2015 03:48:29 PM Eastern Daylight Time	05/24/2015 07:18:29 PM Eastern Daylight Time				07/10/2015 12:40:11 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-055 (PFFS)	04	09	1	1			H8145	055	0	2016	Select Counties in Pennsylvania		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	061	0	1	09	04	H8145_061_0	3		1	07/08/2015	2016.01	07/08/2015 02:50:25 PM Eastern Daylight Time	07/31/2015 05:42:42 PM Eastern Daylight Time	07/30/2015 12:43:38 AM Eastern Daylight Time			08/04/2015 01:19:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-061 (PFFS)	04	09	1	1			H8145	061	0	2016	Select Counties in Florida		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	063	0	1	09	04	H8145_063_0	3		1	07/08/2015	2016.01	07/08/2015 03:28:37 PM Eastern Daylight Time	07/31/2015 04:27:57 PM Eastern Daylight Time	07/30/2015 12:44:14 AM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-063 (PFFS)	04	09	1	1			H8145	063	0	2016	North Carolina Select		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	069	0	1	09	04	H8145_069_0	4		1	07/15/2015	2016.01	07/15/2015 01:40:15 PM Eastern Daylight Time	08/01/2015 06:41:14 PM Eastern Daylight Time	07/30/2015 12:44:48 AM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-069 (PFFS)	04	09	1	1			H8145	069	0	2016	Select Counties in Georgia and South Carolina		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	075	0	1	09	04	H8145_075_0	3		1	07/08/2015	2016.01	07/08/2015 02:53:38 PM Eastern Daylight Time	08/01/2015 09:57:54 AM Eastern Daylight Time	07/30/2015 12:45:24 AM Eastern Daylight Time			08/04/2015 01:19:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-075 (PFFS)	04	09	1	1			H8145	075	0	2016	Select Counties in Alabama		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 02:51:35 PM Eastern Daylight Time	07/31/2015 04:48:02 PM Eastern Daylight Time	07/30/2015 12:46:00 AM Eastern Daylight Time			08/04/2015 03:22:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-084 (PFFS)	04	09	1	1			H8145	084	0	2016	Select Counties in Texas		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	087	0	1	09	04	H8145_087_0	3		1	07/08/2015	2016.01	07/08/2015 02:59:01 PM Eastern Daylight Time	08/03/2015 02:12:58 PM Eastern Daylight Time	07/30/2015 12:46:36 AM Eastern Daylight Time			08/04/2015 12:49:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-087 (PFFS)	04	09	1	1			H8145	087	0	2016	Select Counties in Mississippi		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	08/03/2015	2016.01	08/03/2015 12:41:39 PM Eastern Daylight Time	08/04/2015 10:43:31 AM Eastern Daylight Time	07/30/2015 12:47:12 AM Eastern Daylight Time			08/04/2015 12:55:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-089 (PFFS)	04	09	1	1			H8145	089	0	2016	Select Counties in IA, MN, MT, ND, SD		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 02:57:07 PM Eastern Daylight Time	08/01/2015 09:58:15 AM Eastern Daylight Time	07/30/2015 12:47:48 AM Eastern Daylight Time			08/04/2015 01:19:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-091 (PFFS)	04	09	1	1			H8145	091	0	2016	Select Counties in Virginia		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	093	0	1	09	04	H8145_093_0	3		1	07/08/2015	2016.01	07/08/2015 01:00:18 PM Eastern Daylight Time	08/03/2015 11:28:11 AM Eastern Daylight Time	07/30/2015 12:48:24 AM Eastern Daylight Time			08/04/2015 01:38:24 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-093 (PFFS)	04	09	1	1			H8145	093	0	2016	Select Counties in Oregon and Idaho		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	097	0	1	09	04	H8145_097_0	2		1	07/08/2015	2016.01	07/08/2015 12:59:40 PM Eastern Daylight Time	05/28/2015 02:53:20 PM Eastern Daylight Time				07/10/2015 01:59:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-097 (PFFS)	04	09	1	1			H8145	097	0	2016	Select Counties in ID, MT, OR and WA		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	103	0	1	09	04	H8145_103_0	3		1	07/08/2015	2016.01	07/08/2015 11:55:29 AM Eastern Daylight Time	07/31/2015 04:03:10 PM Eastern Daylight Time	07/30/2015 12:48:58 AM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-103 (PFFS)	04	09	1	1			H8145	103	0	2016	Select Counties in Arizona		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	108	0	1	09	04	H8145_108_0	2		1	07/08/2015	2016.01	07/08/2015 03:00:44 PM Eastern Daylight Time	05/24/2015 07:24:02 PM Eastern Daylight Time				07/10/2015 03:06:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-108 (PFFS)	04	09	1	1			H8145	108	0	2016	Select Counties in Virginia		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	120	0	1	09	04	H8145_120_0	2		1	07/08/2015	2016.01	07/08/2015 03:18:23 PM Eastern Daylight Time	05/25/2015 11:15:28 AM Eastern Daylight Time				07/10/2015 01:42:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-120 (PFFS)	04	09	1	1			H8145	120	0	2016	Select Counties in AR, CO, KS, MO and OK		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(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	07/08/2015	2016.01	07/08/2015 01:33:48 PM Eastern Daylight Time	05/27/2015 03:11:23 PM Eastern Daylight Time				07/10/2015 02:57:52 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-121 (PFFS)	04	09	1	1			H8145	121	0	2016	Select Counties in Illinois and Michigan		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	122	0	1	09	04	H8145_122_0	3		1	07/08/2015	2016.01	07/08/2015 03:19:44 PM Eastern Daylight Time	08/03/2015 10:52:04 AM Eastern Daylight Time	07/30/2015 12:49:34 AM Eastern Daylight Time			08/04/2015 01:00:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-122 (PFFS)	04	09	1	1			H8145	122	0	2016	Select Counties in Arkansas, Kansas and Oklahoma		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 02:51:56 PM Eastern Daylight Time	08/03/2015 04:14:48 PM Eastern Daylight Time	07/30/2015 12:50:10 AM Eastern Daylight Time			08/04/2015 03:15:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-123 (PFFS)	04	09	1	1			H8145	123	0	2016	Select Counties in Colorado and New Mexico		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	01	4b;8a1;8a2;8b3;	
H8145	125	0	1	09	04	H8145_125_0	3		1	07/08/2015	2016.01	07/08/2015 03:20:32 PM Eastern Daylight Time	08/03/2015 10:53:01 AM Eastern Daylight Time	07/30/2015 12:50:46 AM Eastern Daylight Time			08/04/2015 01:00:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-125 (PFFS)	04	09	1	1			H8145	125	0	2016	Select Counties in Missouri		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	07/08/2015	2016.01	07/08/2015 02:52:12 PM Eastern Daylight Time	05/24/2015 03:20:58 PM Eastern Daylight Time				07/10/2015 02:16:13 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-126 (PFFS)	04	09	1	1			H8145	126	0	2016	Select Counties in Texas		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	155	0	1	09	04	H8145_155_0	2		1	07/08/2015	2016.01	07/08/2015 12:00:24 PM Eastern Daylight Time	05/28/2015 10:56:38 AM Eastern Daylight Time				07/10/2015 01:59:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-155 (PFFS)	04	09	1	1			H8145	155	0	2016	Select Counties in Iowa		2		2			2								https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8146	001	0	1	01	01	H8146_001_0	7		1	09/17/2015	2016.01	09/17/2015 01:37:59 PM Eastern Daylight Time	08/05/2015 08:26:38 AM Eastern Daylight Time	08/05/2015 08:26:38 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice (HMO)	01	01		1			H8146	001	0	2016	Memphis Area		2	762	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	002	0	1	01	01	H8146_002_0	7		1	09/17/2015	2016.01	09/17/2015 01:39:56 PM Eastern Daylight Time	08/05/2015 08:26:39 AM Eastern Daylight Time	08/05/2015 08:26:39 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice (HMO)	01	01		1			H8146	002	0	2016	Rural Middle/West Area		2	271	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	003	0	1	01	01	H8146_003_0	6		1	09/17/2015	2016.01	09/17/2015 01:41:19 PM Eastern Daylight Time	08/05/2015 08:26:39 AM Eastern Daylight Time	08/05/2015 08:26:39 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice (HMO)	01	01		1			H8146	003	0	2016	Nashville Area		2	253	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	004	0	1	01	01	H8146_004_0	6		1	09/17/2015	2016.01	09/17/2015 01:42:26 PM Eastern Daylight Time	08/05/2015 08:26:40 AM Eastern Daylight Time	08/05/2015 08:26:40 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice (HMO)	01	01		1			H8146	004	0	2016	Rural East Area		2	415	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	005	0	1	01	01	H8146_005_0	6		1	09/17/2015	2016.01	09/17/2015 01:43:47 PM Eastern Daylight Time	08/05/2015 08:26:40 AM Eastern Daylight Time	08/05/2015 08:26:40 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice (HMO)	01	01		1			H8146	005	0	2016	Chattanooga Area		2	690	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	006	0	1	01	01	H8146_006_0	6		1	09/17/2015	2016.01	09/17/2015 01:44:41 PM Eastern Daylight Time	08/05/2015 08:26:41 AM Eastern Daylight Time	08/05/2015 08:26:41 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice (HMO)	01	01		1			H8146	006	0	2016	Knoxville Area		2	569	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	007	0	1	01	01	H8146_007_0	6		1	09/17/2015	2016.01	09/17/2015 01:45:52 PM Eastern Daylight Time	08/05/2015 08:26:41 AM Eastern Daylight Time	08/05/2015 08:26:41 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice (HMO)	01	01		1			H8146	007	0	2016	Tri-Cities Area		2	75	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	008	0	1	01	01	H8146_008_0	6		1	09/17/2015	2016.01	09/17/2015 01:49:05 PM Eastern Daylight Time	08/05/2015 08:26:42 AM Eastern Daylight Time	08/05/2015 08:26:42 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	008	0	2016	Memphis Area		2	230	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	009	0	1	01	01	H8146_009_0	6		1	09/17/2015	2016.01	09/17/2015 01:52:24 PM Eastern Daylight Time	08/05/2015 08:26:42 AM Eastern Daylight Time	08/05/2015 08:26:42 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	009	0	2016	Rural Middle/West Area		2	86	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	010	0	1	01	01	H8146_010_0	6		1	09/17/2015	2016.01	09/17/2015 01:53:35 PM Eastern Daylight Time	08/05/2015 08:26:43 AM Eastern Daylight Time	08/05/2015 08:26:43 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	010	0	2016	Nashville Area		2	134	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	011	0	1	01	01	H8146_011_0	6		1	09/17/2015	2016.01	09/17/2015 01:54:51 PM Eastern Daylight Time	08/05/2015 08:26:43 AM Eastern Daylight Time	08/05/2015 08:26:43 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	011	0	2016	Rural East Area		2	209	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	012	0	1	01	01	H8146_012_0	6		1	09/17/2015	2016.01	09/17/2015 01:56:41 PM Eastern Daylight Time	08/05/2015 08:26:44 AM Eastern Daylight Time	08/05/2015 08:26:44 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	012	0	2016	Chattanooga Area		2	80	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	013	0	1	01	01	H8146_013_0	7		1	09/17/2015	2016.01	09/17/2015 01:57:43 PM Eastern Daylight Time	08/05/2015 08:26:45 AM Eastern Daylight Time	08/05/2015 08:26:45 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	013	0	2016	Knoxville Area		2	163	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8146	014	0	1	01	01	H8146_014_0	6		1	09/17/2015	2016.01	09/17/2015 01:58:47 PM Eastern Daylight Time	08/05/2015 08:26:45 AM Eastern Daylight Time	08/05/2015 08:26:46 AM Eastern Daylight Time			09/18/2015 11:02:10 AM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbstmedicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	014	0	2016	Tri-Cities Area		2	58	2			2							www.bcbstmedicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8170	001	0	1	01	01	H8170_001_0	5		1	08/04/2015	2016.01	08/04/2015 07:02:10 AM Eastern Daylight Time	08/04/2015 12:36:12 PM Eastern Daylight Time	08/04/2015 09:26:03 AM Eastern Daylight Time			08/04/2015 08:00:24 PM Eastern Daylight Time	AMERICA'S 1ST CHOICE OF SOUTH CAROLINA, INC.	America's 1st Choice of South Carolina	www.americas1stchoice.com	AFC Care Rx (HMO)	01	01		1			H8170	001	0	2016	Select Counties in SC		2	0	2			2							www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8170	002	0	1	01	01	H8170_002_0	5		1	07/07/2015	2016.01	07/07/2015 10:39:58 AM Eastern Daylight Time	08/04/2015 12:35:51 PM Eastern Daylight Time	08/04/2015 09:25:53 AM Eastern Daylight Time			08/04/2015 08:00:24 PM Eastern Daylight Time	AMERICA'S 1ST CHOICE OF SOUTH CAROLINA, INC.	America's 1st Choice of South Carolina	www.americas1stchoice.com	AFC Special Care Rx (HMO SNP)	01	01		1			H8170	002	0	2016	Select Counties in SC		2	0	2			1	4		1		00000000000000000010		www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8189	001	0	1	01	01	H8189_001_0	4	2	1	08/03/2015	2016.01	08/03/2015 01:48:23 PM Pacific Daylight Time	08/03/2015 01:25:17 PM Pacific Daylight Time	07/30/2015 12:13:03 PM Pacific Daylight Time			08/04/2015 03:25:50 PM Pacific Daylight Time	MANAGED HEALTH SERVICES, WISCONSIN	MHS Health Wisconsin Advantage	http://advantage.mhswi.com	MHS Health Wisconsin Advantage (HMO SNP)	01	01		1			H8189	001	0	2016	27 Counties: Southeastern, Northeastern, Central		2	1086	2			1	3		1	3		1	http://advantage.mhswi.com/find-a-provider-or-pharmacy/	http://advantage.mhswi.com/prescription-drug-part-d-benefit-information/formulary/	http://advantage.mhswi.com/find-a-provider-or-pharmacy/	(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8197	001	0	1	48	05	H8197_001_0	5		1	08/27/2015	2016.01	08/27/2015 01:35:04 PM Pacific Daylight Time					08/27/2015 01:42:54 PM Pacific Daylight Time	MOLINA HEALTHCARE OF TEXAS, INC.	Molina Healthcare of Texas	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8197	001	0	2016	Bexar, Dallas, El Paso, Harris, and Hidalgo		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)-		2					2					2				
H8213	001	0	1	48	05	H8213_001_0	8		1	07/14/2015	2016.01	07/14/2015 12:35:38 PM Central Daylight Time					07/14/2015 12:50:29 PM Central Daylight Time	SELECT HEALTH OF SOUTH CAROLINA, INC.	FIRST CHOICE VIP CARE PLUS	http://firstchoicevipcareplus.com	First Choice VIP Care PLUS (Medicare-Medicaid Plan)	05	48		1			H8213	001	0	2016	All South Carolina Counties		2		2			2							http://firstchoicevipcareplus.com	http://firstchoicevipcareplus.com	http://firstchoicevipcareplus.com	(888)978-0862		(888)978-0862		(877)694-2314		(877)694-2314		(855)327-0511		(855)327-0511		(877)694-2314		(877)694-2314		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H8237	001	0	1	01	01	H8237_001_0	8		1	08/05/2015	2016.01	08/05/2015 12:28:46 PM Central Daylight Time	06/01/2015 04:45:16 PM Central Daylight Time	06/01/2015 04:56:42 PM Central Daylight Time			08/05/2015 03:59:46 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Vital Traditions	www.swhp.org	Vital Traditions (HMO)	01	01		1			H8237	001	0	2016	Central Texas		2		2			2							www.swhp.org	www.swhp.org	www.swhp.org	(888)423-7633		(888)423-7633		(877)845-3903		(877)845-3903		(888)423-7633		(888)423-7633		(877)845-3903		(877)845-3903		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		2					2					2	2			
H8237	003	0	1	02	01	H8237_003_0	9		1	08/05/2015	2016.01	08/05/2015 12:29:46 PM Central Daylight Time	06/01/2015 04:46:26 PM Central Daylight Time	06/01/2015 05:01:16 PM Central Daylight Time			08/05/2015 03:59:46 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Vital Traditions	www.swhp.org	Vital Traditions (HMO-POS) (HMO-POS)	01	02		1			H8237	003	0	2016	Dallas		2		2			2							www.swhp.org	www.swhp.org	www.swhp.org	(888)412-7633		(888)423-7633		(877)845-3903		(877)845-3903		(888)423-7633		(888)423-7633		(877)845-3903		(877)845-3903		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		(800)735-2988		2					2					2	2			
H8258	001	0	1	48	05	H8258_001_0	4		1	07/10/2015	2016.01	07/10/2015 12:02:02 PM Pacific Daylight Time					07/10/2015 12:12:59 PM Pacific Daylight Time	LOCAL INITIATIVE HEALTH AUTHORITY FOR L.A. COUNTY	L.A. Care Cal MediConnect Plan	www.calmediconnectla.org	L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H8258	001	0	2016	Los Angeles County		2	300	2			2							www.calmediconnectla.org	www.calmediconnectla.org	www.calmediconnectla.org	(888)522-1298		(888)522-1298		(855)522-8243		(855)522-8243		(888)522-1298		(888)522-1298		(855)522-8243		(855)522-8243		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		2					2					2				
H8266	001	0	1	01	01	H8266_001_0	9		1	09/11/2015	2016.01	09/11/2015 11:48:55 AM Eastern Daylight Time	08/05/2015 04:38:16 PM Eastern Daylight Time	08/05/2015 04:30:11 PM Eastern Daylight Time			09/11/2015 02:34:25 PM Eastern Daylight Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Apollo - Constellation Health (HMO)	01	01		1			H8266	001	0	2016	Puerto Rico		2	3060	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H8266	002	0	1	01	01	H8266_002_0	6		1	09/21/2015	2016.01	09/21/2015 09:48:16 AM Eastern Daylight Time	08/05/2015 04:31:57 PM Eastern Daylight Time	08/05/2015 04:28:34 PM Eastern Daylight Time			09/21/2015 09:50:20 AM Eastern Daylight Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Orion - Constellation Health (HMO)	01	01		1			H8266	002	0	2016	Puerto Rico		2	1250	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2	2			
H8289	001	0	1	01	01	H8289_001_0	5		1	07/14/2015	2016.01	07/14/2015 11:58:10 AM Eastern Daylight Time	07/30/2015 04:01:08 PM Eastern Daylight Time	07/30/2015 04:06:00 PM Eastern Daylight Time			08/05/2015 05:15:21 PM Eastern Daylight Time	BLUEGRASS FAMILY HEALTH, INC.	Baptist Health Plan	baptisthealthplan.org/medicare	Baptist Health Advantage (HMO)	01	01		1			H8289	001	0	2016	Central Kentucky		2		2			2							baptisthealthplan.org/medicare	baptisthealthplan.org/medicare	baptisthealthplan.org/medicare	(844)405-1763		(859)335-4150		(844)405-1763		(859)335-4150		(844)405-1763		(859)335-4150		(844)405-1763		(859)335-4150		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		2					2					2	2			
H8289	002	0	1	01	01	H8289_002_0	6		1	07/21/2015	2016.01	07/21/2015 11:23:55 PM Eastern Daylight Time	07/30/2015 04:03:42 PM Eastern Daylight Time	07/30/2015 04:09:34 PM Eastern Daylight Time			08/05/2015 05:15:21 PM Eastern Daylight Time	BLUEGRASS FAMILY HEALTH, INC.	Baptist Health Plan	baptisthealthplan.org/medicare	Baptist Health Advantage (HMO)	01	01		1			H8289	002	0	2016	Southern Kentucky		2		2			2							baptisthealthplan.org/medicare	baptisthealthplan.org/medicare	baptisthealthplan.org/medicare	(844)405-1763		(859)335-4150		(844)405-1763		(859)335-4150		(844)405-1763		(859)335-4150		(844)405-1763		(859)335-4150		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		(859)335-4129		2					2					2	2			
H8420	001	0	1	48	05	H8420_001_0	3		1	08/11/2015	2016.01	08/11/2015 09:14:53 AM Central Daylight Time					08/11/2015 10:07:02 AM Central Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight Healthcare FIDA Plan	centerlighthealthcare.org	CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H8420	001	0	2016	Ki, Qu, Brx, NY, Ri, Wes, Suf, Na		2		2			2							http://www.centerlighthealthcare.org/images/uploads/2013_CLHC_Direct_Provider_Directory_Complete_-_v	centerlighthealthcare.org	www.navitus.com	(877)226-8500		(347)640-6280		(877)226-8500		(347)640-6280		(800)922-1557		(800)922-1557		(877)226-8500		(877)226-8500		(711)-		(711)-		(711)-		(711)-		(800)922-1557		(800)922-1557		(711)-		(711)-		2					2					2				
H8423	001	0	1	48	05	H8423_001_0	5		1	09/04/2015	2016.01	09/04/2015 09:32:51 AM Central Daylight Time					09/04/2015 12:41:08 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring CarePlan	www.cignahealthspring.com	Cigna-HealthSpring CarePlan (Medicare-Medicaid Plan)	05	48		1			H8423	001	0	2016	Select TX Counties		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.mycignahealthspring.com	(877)653-0327		(877)653-0327		(800)846-2098		(800)846-2098		(877)653-0327		(877)653-6725		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H8424	001	0	1	20	08	H8424_001_0	3		1	05/28/2015	2016.01	05/28/2015 08:41:16 AM Central Daylight Time		06/01/2015 08:48:48 AM Central Daylight Time			06/01/2015 03:09:12 PM Central Daylight Time	SIOUXLAND PACE, INC.	SIOUXLAND PACE, INC.	www.siouxlandpace.org	Siouxland PACE, INC (PACE)	08	20		1			H8424	001	0	2016	Siouxland PACE, INC		2		2			2								www.siouxlandpace.org	www.siouxlandpace.org									(888)722-3713		(712)224-7223	258	(888)722-3713		(712)224-7223	258									(800)383-4545		(712)224-7253		(800)383-4545		(712)224-7253																
H8424	002	0	1	20	08	H8424_002_0	3		1	05/28/2015	2016.01	05/28/2015 08:41:29 AM Central Daylight Time		06/01/2015 09:03:42 AM Central Daylight Time			06/01/2015 03:17:33 PM Central Daylight Time	SIOUXLAND PACE, INC.	SIOUXLAND PACE, INC.	www.siouxlandpace.org	Siouxland PACE, INC (PACE)	08	20		1			H8424	002	0	2016	Siouxland PACE, INC		2		2			2								www.siouxlandpace.org	www.siouxlandpace.org									(888)722-3713		(712)224-7223		(888)722-3713		(712)224-7223										(800)383-4545		(712)224-7253		(800)383-4545		(712)224-7253																
H8432	002	0	1	01	01	H8432_002_0	7	2	1	07/31/2015	2016.01	07/31/2015 01:59:51 PM Eastern Daylight Time	08/01/2015 09:49:55 PM Eastern Daylight Time	07/30/2015 07:33:59 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H8432	002	0	2016	Select Counties in Maine		2	1743	2			1	3		1	5				www.anthem.com/medicare	www.anthem.com/medicare	(855)310-2472		(855)310-2472		(844)316-0358		(844)316-0358		(855)310-2472		(855)310-2472		(844)316-0358		(844)316-0358		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	003	0	1	01	01	H8432_003_0	7		1	08/04/2015	2016.01	08/04/2015 11:14:48 AM Eastern Daylight Time	08/04/2015 10:38:02 AM Eastern Daylight Time	07/30/2015 06:21:52 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H8432	003	0	2016	Select Counties in Maine		2	538	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	004	0	1	01	01	H8432_004_0	7		1	07/20/2015	2016.01	07/20/2015 09:42:19 AM Eastern Daylight Time	08/01/2015 09:51:02 PM Eastern Daylight Time	07/30/2015 06:35:45 PM Eastern Daylight Time			08/05/2015 03:43:55 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H8432	004	0	2016	Penobscot County		2	41	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	801	0	1	01	01	H8432_801_0	3		1	05/20/2015	2016.01	05/20/2015 11:30:50 AM Pacific Daylight Time	05/31/2015 03:03:58 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H8432	801	0	2016	Select Counties in Maine		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H8432	802	0	1	01	01	H8432_802_0	3		1	05/20/2015	2016.01	05/20/2015 11:30:53 AM Pacific Daylight Time	05/31/2015 03:04:03 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H8432	802	0	2016	Select Counties in Maine		1	50	2			2							www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H8452	001	0	1	48	05	H8452_001_0	4		1	08/14/2015	2016.01	08/14/2015 10:22:22 AM Eastern Daylight Time					08/14/2015 10:25:49 AM Eastern Daylight Time	CARESOURCE	CareSource MyCare Ohio	CareSource.com/MyCare	CareSource MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H8452	001	0	2016	12 Counties/3 Regions in the State of Ohio		2	25000	2			2							CareSource.com	CareSource.com/MyCare	www.caresource.com	(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		2					2					2				
H8490	001	0	1	48	05	H8490_001_0	10		1	08/26/2015	2016.01	08/26/2015 04:35:19 PM Eastern Daylight Time					08/26/2015 05:11:31 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)	05	48		1			H8490	001	0	2016	Ki, Qu, Brx, NY, Ri, Wes, Suf and Na		2	9000	2			2								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				
H8506	001	0	1	01	01	H8506_001_0	4		1	07/30/2015	2016.01	07/30/2015 03:00:17 PM Pacific Daylight Time	07/31/2015 10:15:36 AM Pacific Daylight Time	07/31/2015 10:15:35 AM Pacific Daylight Time			07/31/2015 10:23:21 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health HMO (HMO)	01	01		1			H8506	001	0	2016	Eastern Oregon		2	300	2			2							www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8552	020	0	1	04	01	H8552_020_0	10		1	07/27/2015	2016.01	07/27/2015 12:09:04 AM Pacific Daylight Time	08/01/2015 06:51:33 PM Pacific Daylight Time	07/30/2015 03:06:30 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem MediBlue Access (PPO)	01	04		1			H8552	020	0	2016	Orange County		2	3031	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(844)364-2129		(844)364-2129		(877)811-3107		(877)811-3107		(844)364-2124		(844)364-2124		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	021	0	1	04	01	H8552_021_0	10		1	07/20/2015	2016.01	07/20/2015 08:35:38 AM Pacific Daylight Time	08/01/2015 06:52:05 PM Pacific Daylight Time	07/30/2015 03:07:10 PM Pacific Daylight Time			08/05/2015 01:03:51 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem MediBlue Access (PPO)	01	04		1			H8552	021	0	2016	Riverside County		2	1091	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(844)364-2129		(844)364-2129		(877)811-3107		(877)811-3107		(844)364-2124		(844)364-2124		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	801	0	1	04	01	H8552_801_0	4		1	05/29/2015	2016.01	05/29/2015 12:36:28 PM Pacific Daylight Time	05/31/2015 09:39:14 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	801	0	2016	California		1	1807	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H8552	802	0	1	04	01	H8552_802_0	4		1	05/29/2015	2016.01	05/29/2015 12:37:01 PM Pacific Daylight Time	05/31/2015 01:18:04 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	802	0	2016	California		1	50	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H8552	803	0	1	04	01	H8552_803_0	4		1	05/29/2015	2016.01	05/29/2015 12:37:24 PM Pacific Daylight Time	05/31/2015 01:18:09 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	803	0	2016	California		1	50	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H8554	001	0	1	01	01	H8554_001_0	13		1	08/05/2015	2016.01	08/05/2015 01:50:40 PM US Mountain Standard Time	08/05/2015 03:27:09 PM US Mountain Standard Time	08/05/2015 03:26:29 PM US Mountain Standard Time			08/05/2015 03:33:15 PM US Mountain Standard Time	ALLEGIAN HEALTH PLANS, INC.	Allegian Advantage	www.allegianadvantage.com	Allegian Advantage (HMO)	01	01		1			H8554	001	0	2016	Cameron, Hidalgo, and Willacy Counties, TX		2	1800	2			2							www.allegianadvantage.com	www.allegianadvantage.com	www.allegianadvantage.com	(855)805-4152		(855)805-4152		(844)298-7900		(855)805-4152		(855)805-4152		(855)805-4152		(844)298-7900		(855)805-4152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8554	002	0	1	01	01	H8554_002_0	12		1	08/05/2015	2016.01	08/05/2015 01:51:00 PM US Mountain Standard Time	08/05/2015 03:26:56 PM US Mountain Standard Time	08/05/2015 03:27:18 PM US Mountain Standard Time			08/05/2015 03:39:19 PM US Mountain Standard Time	ALLEGIAN HEALTH PLANS, INC.	Allegian Advantage	www.allegianadvantage.com	Allegian Advantage Select (HMO)	01	01		1			H8554	002	0	2016	Cameron, Hidalgo, and Willacy Counties, TX		2	1800	2			2							www.allegianadvantage.com	www.allegianadvantage.com	http://www.allegianadvantage.com/for-members/prescription-drug-information	(855)805-4152		(855)805-4152		(844)298-7900		(855)805-4152		(855)805-4152		(855)805-4152		(844)298-7900		(855)805-4152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	001	0	1	01	01	H8578_001_0	6		1	08/05/2015	2016.01	08/05/2015 01:40:25 PM Eastern Daylight Time	08/03/2015 02:39:58 PM Eastern Daylight Time	07/29/2015 06:02:44 PM Eastern Daylight Time			08/05/2015 03:10:03 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Premium (HMO)	01	01		1			H8578	001	0	2016	Hampden, Hampshire, Franklin, Berkshire Counties		2	3655	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	003	0	1	01	01	H8578_003_0	5		1	07/10/2015	2016.01	07/10/2015 11:05:56 AM Eastern Daylight Time	05/30/2015 08:16:44 PM Eastern Daylight Time				07/10/2015 02:11:03 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Premium No Rx (HMO)	01	01		1			H8578	003	0	2016	Hampden, Hampshire, Franklin, Berkshire Counties		2	190	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370										2					2					2	2			
H8578	004	0	1	01	01	H8578_004_0	6		1	07/10/2015	2016.01	07/10/2015 11:08:41 AM Eastern Daylight Time	08/03/2015 02:40:32 PM Eastern Daylight Time	07/29/2015 06:03:08 PM Eastern Daylight Time			08/05/2015 03:10:03 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Plus (HMO)	01	01		1			H8578	004	0	2016	Hampden, Hampshire, Franklin, Berkshire Counties		2	2837	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	007	0	1	01	01	H8578_007_0	6		1	07/10/2015	2016.01	07/10/2015 11:11:47 AM Eastern Daylight Time	08/03/2015 02:41:06 PM Eastern Daylight Time	07/29/2015 06:03:32 PM Eastern Daylight Time			08/05/2015 03:10:03 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Basic (HMO)	01	01		1			H8578	007	0	2016	Hampden, Hampshire, Franklin, Berkshire Counties		2	1471	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	009	0	1	01	01	H8578_009_0	5		1	07/10/2015	2016.01	07/10/2015 11:23:11 AM Eastern Daylight Time	05/30/2015 08:16:44 PM Eastern Daylight Time				07/10/2015 02:11:03 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Basic No Rx (HMO)	01	01		1			H8578	009	0	2016	Hampden, Hampshire, Franklin, Berkshire Counties		2	191	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370										2					2					2	2			
H8578	012	0	1	01	01	H8578_012_0	6		1	07/10/2015	2016.01	07/10/2015 11:25:10 AM Eastern Daylight Time	08/03/2015 02:41:40 PM Eastern Daylight Time	07/29/2015 06:03:56 PM Eastern Daylight Time			08/05/2015 03:10:03 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Value (HMO)	01	01		1			H8578	012	0	2016	Hampden, Hampshire, Franklin, Berkshire Counties		2	243	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	013	0	1	01	01	H8578_013_0	7		1	07/10/2015	2016.01	07/10/2015 11:30:33 AM Eastern Daylight Time	08/03/2015 02:42:14 PM Eastern Daylight Time	07/29/2015 06:04:20 PM Eastern Daylight Time			08/05/2015 03:10:03 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Premier 1 (HMO)	01	01		1			H8578	013	0	2016	Hartford and Tolland Counties		2	167	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	014	0	1	01	01	H8578_014_0	6		1	07/10/2015	2016.01	07/10/2015 11:32:23 AM Eastern Daylight Time	08/03/2015 02:42:48 PM Eastern Daylight Time	07/29/2015 06:04:44 PM Eastern Daylight Time			08/05/2015 03:10:03 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Premier 2 (HMO)	01	01		1			H8578	014	0	2016	Hartford and Tolland Counties		2	41	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	015	0	1	02	01	H8578_015_0	6		1	07/10/2015	2016.01	07/10/2015 11:38:34 AM Eastern Daylight Time	08/03/2015 04:55:14 PM Eastern Daylight Time	07/29/2015 06:05:12 PM Eastern Daylight Time			08/05/2015 03:10:03 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Premier 3 (HMO-POS)	01	02		1			H8578	015	0	2016	Hartford and Tolland Counties		2	37	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2	2			
H8578	801	0	1	02	01	H8578_801_0	3		1	05/29/2015	2016.01	05/29/2015 04:17:22 PM Eastern Daylight Time	05/30/2015 08:16:44 PM Eastern Daylight Time				05/30/2015 08:51:55 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Employer Group RX (HMO-POS)	01	02		1			H8578	801	0	2016	United States		1	1000	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		1	2		2		1	2		2		1	2			
H8578	802	0	1	02	01	H8578_802_0	3		1	05/29/2015	2016.01	05/29/2015 04:18:20 PM Eastern Daylight Time	05/30/2015 08:16:45 PM Eastern Daylight Time				05/30/2015 08:51:55 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Employer Group Calendar (HMO-POS)	01	02		1			H8578	802	0	2016	United States		1	5	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370										1	2		2		1	2		2		1	2			
H8578	803	0	1	02	01	H8578_803_0	3		1	05/29/2015	2016.01	05/29/2015 04:19:54 PM Eastern Daylight Time	05/30/2015 08:16:45 PM Eastern Daylight Time				05/30/2015 08:51:55 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Employer Group Non-Calendar (HMO-POS)	01	02		1			H8578	803	0	2016	United States		1	5	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		1	2		2		1	2		2		1	2			
H8604	010	0	1	04	01	H8604_010_0	11		1	07/24/2015	2016.01	07/24/2015 11:53:23 AM Eastern Daylight Time	07/30/2015 05:44:34 PM Eastern Daylight Time	07/30/2015 01:24:14 PM Eastern Daylight Time			07/30/2015 06:11:05 PM Eastern Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice - Option II (PPO)	01	04		1			H8604	010	0	2016	Eastern OH		2	200	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		2					2						2			
H8604	011	0	1	04	01	H8604_011_0	12		1	07/24/2015	2016.01	07/24/2015 11:53:46 AM Eastern Daylight Time	07/30/2015 05:43:02 PM Eastern Daylight Time	07/30/2015 01:27:14 PM Eastern Daylight Time			07/30/2015 06:11:05 PM Eastern Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice - Option II (PPO)	01	04		1			H8604	011	0	2016	Southeastern OH, West Virginia		2	600	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		2					2						2			
H8604	013	0	1	04	01	H8604_013_0	10		1	07/24/2015	2016.01	07/24/2015 04:59:12 PM Eastern Daylight Time	07/30/2015 05:40:22 PM Eastern Daylight Time	07/30/2015 01:31:20 PM Eastern Daylight Time			07/30/2015 06:11:05 PM Eastern Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice Capitol Plan (PPO)	01	04		1			H8604	013	0	2016	Kanawha County, West Virginia		2	200	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7917		(800)622-3925		(740)695-7917		(800)622-3925		(740)695-7917		(800)622-3925		(740)695-7917		2					2						1	01	8a1;8b1;8b3;9a;9b;	
H8604	801	0	1	04	01	H8604_801_0	6		1	05/27/2015	2016.01	05/27/2015 05:54:51 PM Eastern Daylight Time	07/21/2015 03:12:03 PM Eastern Daylight Time				07/21/2015 03:15:01 PM Eastern Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice - Employer (PPO)	01	04		1			H8604	801	0	2016	Eastern Ohio and Northern West Virginia		1	132	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;16b;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8b1;8b2;8b3;9a;9b;9c;12;16b;	1						2			
H8634	001	0	1	04	01	H8634_001_0	8		1	07/16/2015	2016.01	07/16/2015 12:59:14 PM Central Daylight Time	08/03/2015 03:42:22 PM Central Daylight Time	08/03/2015 02:45:40 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicareok.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	001	0	2016	Oklahoma City Metro Area		2		2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	002	0	1	04	01	H8634_002_0	9		1	07/16/2015	2016.01	07/16/2015 12:59:35 PM Central Daylight Time	08/03/2015 03:42:56 PM Central Daylight Time	08/03/2015 02:44:30 PM Central Daylight Time			08/04/2015 12:48:52 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicarenm.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	002	0	2016	Benalillo, Sandoval Torrance and Valencia counties		2		2			2							www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	003	0	1	04	01	H8634_003_0	10		1	08/03/2015	2016.01	08/03/2015 02:46:51 PM Central Daylight Time	08/03/2015 03:43:36 PM Central Daylight Time	08/03/2015 02:47:38 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	003	0	2016	Chicago Metro Area		2	376	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	004	0	1	04	01	H8634_004_0	11		1	08/03/2015	2016.01	08/03/2015 02:45:59 PM Central Daylight Time	08/03/2015 03:44:10 PM Central Daylight Time	08/03/2015 02:48:40 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H8634	004	0	2016	Chicago Metro Area		2	94	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	006	0	1	04	01	H8634_006_0	10		1	08/03/2015	2016.01	08/03/2015 02:46:28 PM Central Daylight Time	08/03/2015 03:44:44 PM Central Daylight Time	08/03/2015 02:47:00 PM Central Daylight Time			08/04/2015 10:58:02 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.hcsc.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	006	0	2016	Greater Oklahoma Area		2	504	2			2								https://myprime.com	www.yourpartd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	801	0	1	04	01	H8634_801_0	3		1	05/01/2015	2016.01	05/04/2015 09:14:39 AM Mountain Daylight Time	05/31/2015 02:26:03 PM Central Daylight Time				05/31/2015 03:55:14 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicarenm.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	801	0	2016	State of New Mexico		1	50965	2			2							www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H8634	803	0	1	04	01	H8634_803_0	3		1	05/01/2015	2016.01	05/04/2015 09:51:34 AM Mountain Daylight Time	05/31/2015 02:26:40 PM Central Daylight Time				05/31/2015 03:55:14 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicarenm.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	803	0	2016	State of New Mexico		1	50965	2			2							www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H8634	805	0	1	04	01	H8634_805_0	3		1	05/04/2015	2016.01	05/04/2015 10:33:12 AM Mountain Daylight Time	05/31/2015 04:06:48 PM Central Daylight Time				05/31/2015 04:20:57 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicarenm.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	805	0	2016	State of New Mexico		1	50965	2			2							www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H8634	807	0	1	04	01	H8634_807_0	3		1	05/01/2015	2016.01	05/04/2015 11:16:41 AM Mountain Daylight Time	05/31/2015 02:27:55 PM Central Daylight Time				05/31/2015 03:55:14 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicareok.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	807	0	2016	State of Oklahoma		1	50965	2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H8634	809	0	1	04	01	H8634_809_0	3		1	05/01/2015	2016.01	05/04/2015 11:59:40 AM Mountain Daylight Time	05/31/2015 02:28:32 PM Central Daylight Time				05/31/2015 03:55:14 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicareok.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	809	0	2016	State of Oklahoma		1	50965	2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H8634	811	0	1	04	01	H8634_811_0	3		1	05/04/2015	2016.01	05/04/2015 12:57:37 PM Mountain Daylight Time	05/31/2015 04:07:25 PM Central Daylight Time				05/31/2015 04:20:57 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemedicareok.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	811	0	2016	State of Oklahoma		1	50965	2			2							www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H8634	813	0	1	04	01	H8634_813_0	5		1	05/29/2015	2016.01	05/29/2015 07:12:37 PM Central Daylight Time	05/31/2015 02:29:47 PM Central Daylight Time				05/31/2015 03:09:08 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com	Blue Cross Medicare Advantage (PPO)	01	04		1			H8634	813	0	2016	State of Illinois		1	4719	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H8634	815	0	1	04	01	H8634_815_0	5		1	05/29/2015	2016.01	05/29/2015 07:14:24 PM Central Daylight Time	05/31/2015 02:30:24 PM Central Daylight Time				05/31/2015 03:09:08 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com	Blue Cross Medicare Advantage (PPO)	01	04		1			H8634	815	0	2016	State of Illinois		1	4719	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H8634	817	0	1	04	01	H8634_817_0	7		1	05/01/2015	2016.01	05/01/2015 01:04:13 PM Central Daylight Time	05/31/2015 04:08:03 PM Central Daylight Time				05/31/2015 05:59:35 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.getblueil.com	Blue Cross Medicare Advantage (PPO)	01	04		1			H8634	817	0	2016	State of Illinois		1	4719	2			2							www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;8b1;8b2;11a;11b;	2		1						2			
H8649	003	0	1	01	01	H8649_003_0	9		1	08/01/2015	2016.01	08/01/2015 02:21:05 AM Mountain Daylight Time	08/04/2015 11:32:44 AM Mountain Daylight Time	07/29/2015 03:59:01 PM Mountain Daylight Time			08/04/2015 12:51:48 PM Mountain Daylight Time	AETNA HEALTH OF UTAH, INC.	Altius Health Plans	www.altiusadvantra.com	Altius Advantra (HMO)	01	01		1			H8649	003	0	2016	Northern Utah		2	10270	2			2							www.altiusadvantra.com	http://AltiusFormulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(866)784-4918		(866)784-4918		(855)338-9559		(855)338-9559		(800)708-3650		(800)708-3650		(855)338-9559		(855)338-9559		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8649	008	0	1	01	01	H8649_008_0	8		1	06/01/2015	2016.01	06/01/2015 07:00:02 PM Mountain Daylight Time	08/04/2015 10:30:26 AM Mountain Daylight Time	07/29/2015 03:59:21 PM Mountain Daylight Time			08/04/2015 12:55:03 PM Mountain Daylight Time	AETNA HEALTH OF UTAH, INC.	Altius Health Plans	www.altiusadvantra.com	Altius Advantra Select (HMO)	01	01		1			H8649	008	0	2016	UT- Uintah, Duchesne / WY-Uinta		2	10708	2			2							www.altiusadvantra.com	http://AltiusFormulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(866)784-4918		(866)784-4918		(855)338-9559		(855)338-9559		(800)708-3650		(800)708-3650		(855)338-9559		(855)338-9559		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8649	801	0	1	01	01	H8649_801_0	4		1	06/01/2015	2016.01	06/01/2015 08:50:33 AM Mountain Daylight Time	06/22/2015 10:21:04 AM Mountain Daylight Time				07/17/2015 04:50:39 PM Mountain Daylight Time	AETNA HEALTH OF UTAH, INC.	Altius Health Plans	www.altiusadvantra.com	Altius Advantra Emp Calendar Year (HMO)	01	01		1			H8649	801	0	2016	State of Utah		1	0	2			2							www.altiusadvantra.com	http://AltiusFormulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(866)784-4918		(866)784-4918		(855)338-9559		(855)338-9559		(800)708-3650		(800)708-3650		(855)338-9559		(855)338-9559		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8649	803	0	1	01	01	H8649_803_0	4		1	06/01/2015	2016.01	06/01/2015 08:50:24 AM Mountain Daylight Time	06/22/2015 10:22:25 AM Mountain Daylight Time				07/17/2015 04:52:45 PM Mountain Daylight Time	AETNA HEALTH OF UTAH, INC.	Altius Health Plans	www.altiusadvantra.com	Altius Advantra Emp MA Only (HMO)	01	01		1			H8649	803	0	2016	State of Utah		1	0	2			2							www.altiusadvantra.com	http://AltiusFormulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(866)784-4918		(866)784-4918		(855)338-9559		(855)338-9559										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8655	004	0	1	20	08	H8655_004_0	3		1	07/16/2015	2016.01	07/16/2015 11:41:59 AM Eastern Daylight Time		07/14/2015 04:32:01 PM Eastern Daylight Time			07/16/2015 11:44:40 AM Eastern Daylight Time	RIVERSIDE RETIREMENT SERVICES, INC.	Riverside PACE	www.riversideonline.com	Riverside PACE Dual (PACE)	08	20		1			H8655	004	0	2016	Riverside PACE Dual		2		2			2								N/A - no formulary	www.riversideonline.com									(800)675-6368		(757)875-2050		(800)675-6368		(757)875-2050										(800)675-6368		(757)875-2050		(800)675-6368		(757)875-2050																
H8655	005	0	1	20	08	H8655_005_0	3		1	07/16/2015	2016.01	07/16/2015 11:42:12 AM Eastern Daylight Time		07/14/2015 05:09:57 PM Eastern Daylight Time			07/16/2015 11:44:40 AM Eastern Daylight Time	RIVERSIDE RETIREMENT SERVICES, INC.	Riverside PACE	www.riversideonline.com	Riverside PACE Medicare ONLY (PACE)	08	20		1			H8655	005	0	2016	Riverside PACE Medicare ONLY		2		2			2								N/A - no formulary	www.riversideonline.com									(800)675-6368		(757)875-2050		(800)675-6368		(757)875-2050										(800)675-6368		(757)875-2050		(800)675-6368		(757)875-2050																
H8677	001	0	1	48	05	H8677_001_0	5		1	08/13/2015	2016.01	08/13/2015 09:08:15 AM Pacific Daylight Time					08/13/2015 09:43:36 AM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8677	001	0	2016	Southern California		2		2			2							www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H8677	002	0	1	48	05	H8677_002_0	5		1	08/13/2015	2016.01	08/13/2015 09:07:27 AM Pacific Daylight Time					08/13/2015 09:43:36 AM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8677	002	0	2016	Los Angeles		2		2			2							www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H8748	002	0	1	01	01	H8748_002_0	3		1	07/31/2015	2016.01	07/31/2015 02:32:29 PM Central Daylight Time	07/31/2015 01:12:05 PM Central Daylight Time	07/30/2015 10:43:45 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H8748	002	0	2016	Greenville county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8764	001	0	1	01	01	H8764_001_0	11		1	08/10/2015	2016.01	08/10/2015 08:01:30 AM Central Daylight Time	08/05/2015 12:36:28 PM Central Daylight Time	08/05/2015 12:06:40 PM Central Daylight Time			08/10/2015 12:11:32 PM Central Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Advantage (HMO)	01	01		1			H8764	001	0	2016	Monterey County		2		2			2							www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(855)570-1600		(831)574-4938		(866)632-7958		(866)632-7958		(855)570-1600		(831)574-4938		(855)332-7195		(831)574-4940		(855)332-7195		(831)574-4940		(866)706-4757		(866)706-4757		(855)332-7195		(831)574-4940		2					2					2	2			
H8764	002	0	1	02	01	H8764_002_0	9		1	07/07/2015	2016.01	07/07/2015 11:51:35 AM Central Daylight Time	08/05/2015 12:37:17 PM Central Daylight Time	08/05/2015 12:10:40 PM Central Daylight Time			08/05/2015 01:39:54 PM Central Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Advantage Plus (HMO-POS)	01	02		1			H8764	002	0	2016	Monterey County		2		2			2							www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(855)570-1600		(831)574-4938		(866)632-7958		(866)632-7958		(855)570-1600		(831)574-4938		(855)332-7195		(831)574-4940		(855)332-7195		(831)574-4940		(866)706-4757		(866)706-4757		(855)332-7195		(831)574-4940		2					2					2	2			
H8764	003	0	1	01	01	H8764_003_0	11		1	07/17/2015	2016.01	07/17/2015 01:54:17 PM Central Daylight Time	08/05/2015 10:52:09 AM Central Daylight Time	08/05/2015 12:12:29 PM Central Daylight Time			08/05/2015 01:39:54 PM Central Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Advantage Value (HMO)	01	01		1			H8764	003	0	2016	Monterey County		2		2			2							www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(855)570-1600		(831)574-4938		(866)632-7958		(866)632-7958		(855)570-1600		(831)574-4938		(855)332-7195		(831)574-4940		(855)332-7195		(831)574-4940		(866)706-4757		(866)706-4757		(855)332-7195		(831)574-4940		2					2					2	2			
H8769	001	0	1	20	08	H8769_001_0	1		1	09/10/2015	2016.01	09/10/2015 11:08:24 AM Eastern Daylight Time		08/10/2015 05:04:23 PM Eastern Daylight Time			09/10/2015 11:14:35 AM Eastern Daylight Time	GENESYS HEALTH SYSTEM	Genesys PACE of Genesee County	GenesysPACE.org	Genesys PACE of Genesee County (PACE)	08	20		1			H8769	001	0	2016	Genesee County		2		2			2								genesyspace.org	genesyspace.org									(800)000-0000		(810)236-7500		(800)000-0000		(810)236-7500										(888)-		(888)-		(888)-		(888)-																
H8769	002	0	1	20	08	H8769_002_0	1		1	09/10/2015	2016.01	09/10/2015 11:09:03 AM Eastern Daylight Time		08/10/2015 05:15:08 PM Eastern Daylight Time			09/10/2015 11:14:35 AM Eastern Daylight Time	GENESYS HEALTH SYSTEM	Genesys PACE of Genesee County	GenesysPACE.org	Genesys PACE of Genesee County(PACE) (PACE)	08	20		1			H8769	002	0	2016	Genesee County		2		2			2								genesyspace.org	genesyspace.org									(800)000-0000		(810)236-7500		(800)000-0000		(810)236-7500										(888)-		(888)-		(888)-		(888)-																
H8777	001	0	1	20	08	H8777_001_0	1		1	05/20/2015	2016.01	05/20/2015 02:54:17 PM Eastern Daylight Time		05/18/2015 08:43:15 AM Eastern Daylight Time			05/20/2015 02:56:13 PM Eastern Daylight Time	COMPLETE SENIOR CARE, INC.	Complete Senior Care	completeseniorcare.org	Complete Senior Care Dual (PACE)	08	20		1			H8777	001	0	2016	Niagara, NY		2		2			2								completeseniorcare.org	completeseniorcare.org									(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	05/20/2015	2016.01	05/20/2015 02:54:28 PM Eastern Daylight Time		05/18/2015 08:44:31 AM Eastern Daylight Time			05/20/2015 02:56:13 PM Eastern Daylight Time	COMPLETE SENIOR CARE, INC.	Complete Senior Care	completeseniorcare.org	Complete Senior Care Medicare Only (PACE)	08	20		1			H8777	002	0	2016	Niagara, NY		2		2			2								completeseniorcare.org	completeseniorcare.org									(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															
H8786	001	0	1	48	05	H8786_001_0	7		1	08/31/2015	2016.01	08/31/2015 04:39:20 PM Eastern Daylight Time					08/31/2015 04:56:20 PM Eastern Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/txmmp	Amerigroup Medicare-Medicaid Plan (Medicare-Medicaid Plan)	05	48		1			H8786	001	0	2016	Select TX Service Areas		2	2000	2			2							www.myamerigroup.com/Medicare	www.myamerigroup.com/txmmp	www.myamerigroup/medicare.com	(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H8800	001	0	1	20	08	H8800_001_0	2		1	06/01/2015	2016.01	06/01/2015 07:53:20 PM Eastern Daylight Time		05/19/2015 11:51:00 AM Eastern Daylight Time			06/01/2015 07:54:15 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	2016	Total Senior Care, Inc.		2		2			2								www.totalseniorcare.org	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	2		1	06/01/2015	2016.01	06/01/2015 07:53:32 PM Eastern Daylight Time		05/19/2015 11:51:00 AM Eastern Daylight Time			06/01/2015 07:54:15 PM Eastern Daylight Time	TOTAL SENIOR CARE, INC.	Total Senior Care, Inc.	totalseniorcare.org	Total Senior Care - Medicare Small Only (PACE)	08	20		1			H8800	002	0	2016	Total Senior Care, Inc.		2		2			2								www.totalseniorcare.org	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																
H8822	004	0	1	01	01	H8822_004_0	13		1	08/05/2015	2016.01	08/05/2015 02:18:29 PM Eastern Daylight Time	08/07/2015 07:28:42 AM Eastern Daylight Time	07/30/2015 04:44:16 PM Eastern Daylight Time			08/07/2015 10:08:51 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Network (HMO)	01	01		1			H8822	004	0	2016	Central Indiana and St. Joseph County		2	1424	2			2							www.advantageplan.com/MAPlans	www.advantageplan.com	www.advantageplan.com	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950		(877)684-0014		(317)573-7950		(800)201-8342		(317)573-7950		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H8822	005	0	1	01	01	H8822_005_0	11	2	1	08/05/2015	2016.01	08/05/2015 11:25:07 AM Eastern Daylight Time	08/04/2015 12:41:53 PM Eastern Daylight Time	07/30/2015 04:46:13 PM Eastern Daylight Time			08/05/2015 04:02:53 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Special Needs Plan (HMO SNP)	01	01		1			H8822	005	0	2016	Central Indiana		2	109	2			1	3		1	2			www.advantageplan.com/MAPlans	www.advantageplan.com	www.advantageplan.com	(800)523-7533		(317)573-7950		(800)201-8342		(317)573-7950		(877)684-0014		(317)573-7950	1	(800)201-8342		(317)573-7950		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2	2			
H8851	001	0	1	48	05	H8851_001_0	7		1	08/26/2015	2016.01	08/26/2015 01:00:48 PM Eastern Daylight Time					08/26/2015 01:03:04 PM Eastern Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	SWH Whole Health FIDA Plan	www.seniorwholehealth.com	SWH Whole Health FIDA (Medicare-Medicaid Plan)	05	48		1			H8851	001	0	2016	Kings, Queens, Bronx, and New York Counties		2	100	2			2							www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(877)353-0185		(646)273-2300		(877)353-0188		(646)273-2300		(877)353-0185		(646)273-2300		(877)353-0188		(646)273-2300		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H8854	001	0	1	01	01	H8854_001_0	7		1	08/05/2015	2016.01	08/05/2015 03:42:35 PM Eastern Daylight Time	08/05/2015 04:40:07 PM Eastern Daylight Time	08/05/2015 04:40:07 PM Eastern Daylight Time			08/05/2015 10:21:28 PM Eastern Daylight Time	RIVERSIDE ADVANTAGE, INC.	University of Maryland Health Advantage	www.UMMedicareAdvantage.org	University of Maryland Health Advantage Complete (HMO)	01	01		1			H8854	001	0	2016	Central and Eastern Maryland Counties		2	4675	2			2							www.UMMedicareAdvantage.org	www.UMMedicareAdvantage.org	www.UMMedicareAdvantage.org	(844)386-6762		(844)386-6762		(844)262-1122		(844)262-1122		(844)786-6762		(844)786-6762		(844)262-1122		(844)262-1122		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8854	002	0	1	01	01	H8854_002_0	9	2	1	08/05/2015	2016.01	08/05/2015 04:07:41 PM Eastern Daylight Time	08/05/2015 04:40:07 PM Eastern Daylight Time	08/05/2015 04:40:07 PM Eastern Daylight Time			08/05/2015 10:21:28 PM Eastern Daylight Time	RIVERSIDE ADVANTAGE, INC.	University of Maryland Health Advantage	www.UMMedicareAdvantage.org	University of Maryland Health Advantage Dual (HMO SNP)	01	01		1			H8854	002	0	2016	Central and Eastern Maryland Counties		2	3825	2			1	3		1	4			www.UMMedicareAdvantage.org	www.UMMedicareAdvantage.org	www.UMMedicareAdvantage.org	(844)486-6762		(844)486-6762		(844)262-1122		(844)262-1122		(844)886-6762		(844)886-6762		(844)262-1122		(844)262-1122		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	001	0	1	01	01	H8908_001_0	3		1	07/08/2015	2016.01	07/08/2015 01:35:25 PM Eastern Daylight Time	08/04/2015 12:01:31 PM Eastern Daylight Time	07/30/2015 12:51:22 AM Eastern Daylight Time			08/04/2015 01:21:45 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana Medical Plan of Michigan, Inc.	www.humana-medicare.com	Humana Gold Plus H8908-001 (HMO)	01	01		1			H8908	001	0	2016	Detroit area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	3		1	07/08/2015	2016.01	07/08/2015 09:24:51 AM Eastern Daylight Time	08/04/2015 11:31:31 AM Eastern Daylight Time	07/30/2015 12:51:58 AM Eastern Daylight Time			08/04/2015 01:21:45 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana Medical Plan of Michigan, Inc.	www.humana-medicare.com	Humana Gold Plus H8908-002 (HMO)	01	01		1			H8908	002	0	2016	Grand Rapids area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(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	05/11/2015	2016.01	05/11/2015 02:45:49 PM Eastern Daylight Time	05/29/2015 08:25:29 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana Medical Plan of Michigan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H8908	801	0	2016	Select Counties in Michigan		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H8908	802	0	1	01	01	H8908_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:46:54 PM Eastern Daylight Time	05/29/2015 08:25:58 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana Medical Plan of Michigan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H8908	802	0	2016	Select Counties in Michigan		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H8953	002	0	1	01	01	H8953_002_0	3		1	07/08/2015	2016.01	07/08/2015 03:15:44 PM Eastern Daylight Time	07/31/2015 05:46:43 PM Eastern Daylight Time	07/30/2015 12:52:34 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-002 (HMO)	01	01		1			H8953	002	0	2016	Select counties in Ohio		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	003	0	1	01	01	H8953_003_0	3		1	07/08/2015	2016.01	07/08/2015 02:56:38 PM Eastern Daylight Time	07/31/2015 05:47:24 PM Eastern Daylight Time	07/30/2015 12:53:10 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-003 (HMO)	01	01		1			H8953	003	0	2016	Select counties in Ohio		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	005	0	1	01	01	H8953_005_0	3		1	07/08/2015	2016.01	07/08/2015 02:56:57 PM Eastern Daylight Time	07/31/2015 05:50:49 PM Eastern Daylight Time	07/30/2015 12:19:16 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-005 (HMO)	01	01		1			H8953	005	0	2016	Columbus Metro area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	006	0	1	01	01	H8953_006_0	3		1	07/07/2015	2016.01	07/07/2015 04:12:51 PM Eastern Daylight Time	07/31/2015 05:51:35 PM Eastern Daylight Time	07/30/2015 12:19:54 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-006 (HMO)	01	01		1			H8953	006	0	2016	Canton Metropolitan Area		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	007	0	1	01	01	H8953_007_0	3	2	1	07/31/2015	2016.01	07/31/2015 01:48:30 PM Eastern Daylight Time	07/31/2015 05:52:15 PM Eastern Daylight Time	07/30/2015 12:20:30 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H8953-007 (HMO SNP)	01	01		1			H8953	007	0	2016	Cincinnati - Columbus Area		2		2			1	3		1	5			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	010	0	1	01	01	H8953_010_0	3		1	07/08/2015	2016.01	07/08/2015 02:57:42 PM Eastern Daylight Time	07/31/2015 05:54:11 PM Eastern Daylight Time	07/30/2015 12:55:34 AM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-010 (HMO)	01	01		1			H8953	010	0	2016	Select Counties in Ohio		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	011	0	1	01	01	H8953_011_0	4		1	07/14/2015	2016.01	07/14/2015 10:35:59 AM Eastern Daylight Time	07/31/2015 05:55:28 PM Eastern Daylight Time	07/30/2015 12:21:06 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus - Diabetes and Heart (HMO SNP)	01	01		1			H8953	011	0	2016	Cincinnati-Columbus area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	014	0	1	01	01	H8953_014_0	4	2	1	07/31/2015	2016.01	07/31/2015 01:50:44 PM Eastern Daylight Time	07/31/2015 05:57:24 PM Eastern Daylight Time	07/30/2015 12:21:42 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H8953-014 (HMO SNP)	01	01		1			H8953	014	0	2016	Northern Kentucky Area		2		2			1	3		1	1			www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	016	0	1	01	01	H8953_016_0	3		1	07/08/2015	2016.01	07/08/2015 02:59:06 PM Eastern Daylight Time	08/01/2015 07:20:28 PM Eastern Daylight Time	07/30/2015 12:22:18 PM Eastern Daylight Time			08/04/2015 02:49:49 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-016 (HMO)	01	01		1			H8953	016	0	2016	Select Counties in Ohio and Kentucky		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	017	0	1	01	01	H8953_017_0	4		1	07/08/2015	2016.01	07/08/2015 02:59:21 PM Eastern Daylight Time	08/01/2015 07:30:50 PM Eastern Daylight Time	07/30/2015 12:22:54 PM Eastern Daylight Time			08/04/2015 02:49:49 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-017 (HMO)	01	01		1			H8953	017	0	2016	Select counties in Ohio		2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	018	1	1	01	01	H8953_018_1	3		1	07/08/2015	2016.01	07/08/2015 03:22:09 PM Eastern Daylight Time	07/31/2015 06:00:38 PM Eastern Daylight Time	07/30/2015 12:23:30 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-018 (HMO)	01	01		1			H8953	018	1	2016	Select counties in Kentucky and Ohio	Select counties in Kentucky	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	018	2	1	01	01	H8953_018_2	3		1	07/08/2015	2016.01	07/08/2015 03:22:52 PM Eastern Daylight Time	07/31/2015 06:01:20 PM Eastern Daylight Time	07/30/2015 12:24:06 PM Eastern Daylight Time			08/04/2015 02:09:23 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-018 (HMO)	01	01		1			H8953	018	2	2016	Select counties in Kentucky and Ohio	Greater Cincinnati area	2		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8953	801	0	1	01	01	H8953_801_0	1		1	05/11/2015	2016.01	05/11/2015 02:47:55 PM Eastern Daylight Time	05/29/2015 08:13:10 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H8953	801	0	2016	Select counties in Cincinnati metro area		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H8953	802	0	1	01	01	H8953_802_0	1		1	05/11/2015	2016.01	05/11/2015 02:48:55 PM Eastern Daylight Time	05/29/2015 08:14:37 AM Eastern Daylight Time				05/29/2015 12:53:33 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H8953	802	0	2016	Select counties in Cincinnati metro area		1		2			2							www.humana.com/members/tools	https://www.humana.com/pharmacy/medicare/tools/druglist/	https://www.humana.com/pharmacy/medicare/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1					1	2			
H9001	001	0	1	01	01	H9001_001_0	4		1	07/21/2015	2016.01	07/21/2015 10:24:30 AM Eastern Daylight Time	06/01/2015 11:35:46 AM Eastern Daylight Time				07/21/2015 03:09:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Standard (HMO)	01	01		1			H9001	001	0	2016	Worcester County and parts of Franklin County		2	223	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	013	0	1	02	01	H9001_013_0	6		1	08/03/2015	2016.01	08/03/2015 09:44:14 AM Eastern Daylight Time	07/31/2015 01:26:00 PM Eastern Daylight Time	07/31/2015 01:40:52 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced Rx (HMO-POS)	01	02		1			H9001	013	0	2016	Worcester County and parts of Franklin County		2	4502	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	015	0	1	01	01	H9001_015_0	5		1	08/03/2015	2016.01	08/03/2015 09:44:20 AM Eastern Daylight Time	07/31/2015 01:26:46 PM Eastern Daylight Time	07/31/2015 01:41:28 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Standard Enhanced Rx (HMO)	01	01		1			H9001	015	0	2016	Worcester County and parts of Franklin County		2	1274	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	019	0	1	01	01	H9001_019_0	4	2	1	07/30/2015	2016.01	07/30/2015 04:09:47 PM Eastern Daylight Time	07/31/2015 01:27:32 PM Eastern Daylight Time	07/31/2015 01:42:04 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.navicare.org	NaviCare (HMO SNP)	01	01		1			H9001	019	0	2016	MA except counties: BER, DUK, NAN and parts of FRA		2	5231	2			1	3		1	5			www.navicare.org/FindPhysician	www.navicare.org/medicare-formulary	www.navicare.org/medicare-pharmacy	(877)700-6996		(877)700-6996		(877)255-7108		(877)255-7108		(877)700-6996		(877)700-6996		(877)255-7108		(877)255-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					1	2			
H9001	029	1	1	01	01	H9001_029_1	4		1	07/21/2015	2016.01	07/21/2015 08:34:34 AM Eastern Daylight Time	06/01/2015 11:36:01 AM Eastern Daylight Time				07/21/2015 03:09:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	1	2016	MA except counties: BER, DUK, NAN and parts of FRA	Essex and Suffolk counties	2	10	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	2	1	01	01	H9001_029_2	4		1	07/21/2015	2016.01	07/21/2015 08:35:11 AM Eastern Daylight Time	06/01/2015 11:36:03 AM Eastern Daylight Time				07/21/2015 03:09:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	2	2016	MA except counties: BER, DUK, NAN and parts of FRA	Middlesex, Norfolk, Bristol and Plymouth counties	2	74	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	4	1	01	01	H9001_029_4	4		1	07/21/2015	2016.01	07/21/2015 08:35:47 AM Eastern Daylight Time	06/01/2015 11:36:06 AM Eastern Daylight Time				07/21/2015 03:09:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	4	2016	MA except counties: BER, DUK, NAN and parts of FRA	Barnstable county	2	1	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	5	1	01	01	H9001_029_5	4		1	07/21/2015	2016.01	07/21/2015 08:36:20 AM Eastern Daylight Time	06/01/2015 11:36:08 AM Eastern Daylight Time				07/21/2015 03:09:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	5	2016	MA except counties: BER, DUK, NAN and parts of FRA	Hampden and Hampshire counties	2	67	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	029	6	1	01	01	H9001_029_6	4		1	07/21/2015	2016.01	07/21/2015 08:37:02 AM Eastern Daylight Time	06/01/2015 11:36:10 AM Eastern Daylight Time				07/21/2015 03:09:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	6	2016	MA except counties: BER, DUK, NAN and parts of FRA	Worcester and parts of Franklin	2	220	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	030	1	1	01	01	H9001_030_1	5		1	08/03/2015	2016.01	08/03/2015 09:44:33 AM Eastern Daylight Time	07/31/2015 01:28:16 PM Eastern Daylight Time	07/31/2015 01:42:40 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced RX (HMO)	01	01		1			H9001	030	1	2016	Cntys: BAR, BRI, ESS, HMD, HMP, MID, NOR, PLY, SUF	Essex and Suffolk counties	2	99	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	2	1	01	01	H9001_030_2	5		1	08/03/2015	2016.01	08/03/2015 09:44:44 AM Eastern Daylight Time	07/31/2015 01:29:02 PM Eastern Daylight Time	07/31/2015 01:43:14 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced RX (HMO)	01	01		1			H9001	030	2	2016	Cntys: BAR, BRI, ESS, HMD, HMP, MID, NOR, PLY, SUF	Middlesex, Norfolk, Bristol and Plymouth counties	2	576	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	4	1	01	01	H9001_030_4	5		1	08/03/2015	2016.01	08/03/2015 09:44:53 AM Eastern Daylight Time	07/31/2015 01:29:48 PM Eastern Daylight Time	07/31/2015 01:43:50 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced RX (HMO)	01	01		1			H9001	030	4	2016	Cntys: BAR, BRI, ESS, HMD, HMP, MID, NOR, PLY, SUF	Barnstable county	2	13	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	030	5	1	01	01	H9001_030_5	5		1	08/03/2015	2016.01	08/03/2015 09:44:59 AM Eastern Daylight Time	07/31/2015 01:30:32 PM Eastern Daylight Time	07/31/2015 01:44:26 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced RX (HMO)	01	01		1			H9001	030	5	2016	Cntys: BAR, BRI, ESS, HMD, HMP, MID, NOR, PLY, SUF	Hampden and Hampshire counties	2	757	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	1	1	01	01	H9001_031_1	5		1	08/03/2015	2016.01	08/03/2015 09:45:06 AM Eastern Daylight Time	07/31/2015 01:31:18 PM Eastern Daylight Time	07/31/2015 01:45:02 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced RX (HMO)	01	01		1			H9001	031	1	2016	BAR, BRI, ESS, MID, NOR, SUF, WOR, and part of FRA	Essex and Suffolk counties	2	50	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	2	1	01	01	H9001_031_2	5		1	08/03/2015	2016.01	08/03/2015 09:45:11 AM Eastern Daylight Time	07/31/2015 01:32:02 PM Eastern Daylight Time	07/31/2015 01:45:38 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced RX (HMO)	01	01		1			H9001	031	2	2016	BAR, BRI, ESS, MID, NOR, SUF, WOR, and part of FRA	Middlesex, Norfolk, Bristol and Plymouth counties	2	489	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	4	1	01	01	H9001_031_4	5		1	08/03/2015	2016.01	08/03/2015 09:45:17 AM Eastern Daylight Time	07/31/2015 01:32:50 PM Eastern Daylight Time	07/31/2015 01:46:14 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced RX (HMO)	01	01		1			H9001	031	4	2016	BAR, BRI, ESS, MID, NOR, SUF, WOR, and part of FRA	Barnstable county	2	6	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	031	6	1	01	01	H9001_031_6	5		1	08/03/2015	2016.01	08/03/2015 09:45:23 AM Eastern Daylight Time	07/31/2015 01:34:06 PM Eastern Daylight Time	07/31/2015 01:46:50 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced RX (HMO)	01	01		1			H9001	031	6	2016	BAR, BRI, ESS, MID, NOR, SUF, WOR, and part of FRA	Worcester and parts of Franklin	2	913	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	1	1	01	01	H9001_032_1	5		1	08/03/2015	2016.01	08/03/2015 09:45:30 AM Eastern Daylight Time	07/31/2015 01:34:52 PM Eastern Daylight Time	07/31/2015 01:47:24 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	1	2016	MA except counties: BER, DUK, NAN and parts of FRA	Essex and Suffolk counties	2	147	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	2	1	01	01	H9001_032_2	5		1	08/03/2015	2016.01	08/03/2015 09:45:42 AM Eastern Daylight Time	07/31/2015 01:35:38 PM Eastern Daylight Time	07/31/2015 01:48:00 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	2	2016	MA except counties: BER, DUK, NAN and parts of FRA	Middlesex, Norfolk, Bristol and Plymouth counties	2	230	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	4	1	01	01	H9001_032_4	5		1	08/03/2015	2016.01	08/03/2015 09:45:47 AM Eastern Daylight Time	07/31/2015 01:36:24 PM Eastern Daylight Time	07/31/2015 01:48:36 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	4	2016	MA except counties: BER, DUK, NAN and parts of FRA	Barnstable county	2	32	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	5	1	01	01	H9001_032_5	5		1	08/03/2015	2016.01	08/03/2015 09:45:53 AM Eastern Daylight Time	07/31/2015 01:37:08 PM Eastern Daylight Time	07/31/2015 01:49:12 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	5	2016	MA except counties: BER, DUK, NAN and parts of FRA	Hampden and Hampshire counties	2	127	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	032	6	1	01	01	H9001_032_6	5		1	08/03/2015	2016.01	08/03/2015 09:45:59 AM Eastern Daylight Time	07/31/2015 01:37:54 PM Eastern Daylight Time	07/31/2015 01:49:48 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	6	2016	MA except counties: BER, DUK, NAN and parts of FRA	Worcester and parts of Franklin	2	1139	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	033	0	1	02	01	H9001_033_0	6		1	08/03/2015	2016.01	08/03/2015 09:46:05 AM Eastern Daylight Time	07/31/2015 01:38:40 PM Eastern Daylight Time	07/31/2015 01:50:24 PM Eastern Daylight Time			08/04/2015 04:26:05 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced Rx (HMO-POS)	01	02		1			H9001	033	0	2016	Hampden and Hampshire Counties		2	681	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	803	0	1	01	01	H9001_803_0	2		1	06/01/2015	2016.01	06/01/2015 10:07:48 AM Eastern Daylight Time	06/01/2015 11:35:25 AM Eastern Daylight Time				06/01/2015 11:56:17 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	MA-PD HMO (HMO)	01	01		1			H9001	803	0	2016	Full Service Area - Employer Groups		1	2516	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	804	0	1	02	01	H9001_804_0	2		1	06/01/2015	2016.01	06/01/2015 10:07:54 AM Eastern Daylight Time	06/01/2015 11:35:31 AM Eastern Daylight Time				06/01/2015 11:56:17 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	MA-PD HMO POS (HMO-POS)	01	02		1			H9001	804	0	2016	Full Service Area - Employer Groups		1	2	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9003	001	0	1	01	01	H9003_001_0	10		1	08/03/2015	2016.01	08/03/2015 12:23:26 PM Pacific Daylight Time	08/03/2015 06:26:37 PM Pacific Daylight Time	08/03/2015 06:46:36 PM Pacific Daylight Time			08/04/2015 03:23:03 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H9003	001	0	2016	Portland-Vancouver Metro, Salem OR, Longview WA		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9003	006	0	1	01	01	H9003_006_0	9		1	08/03/2015	2016.01	08/03/2015 12:24:28 PM Pacific Daylight Time	08/03/2015 06:27:26 PM Pacific Daylight Time	08/03/2015 06:46:57 PM Pacific Daylight Time			08/04/2015 03:23:03 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H9003	006	0	2016	Portland-Vancouver Metro, Salem OR, Longview WA		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(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	6		1	05/27/2015	2016.01	05/27/2015 02:42:34 PM Pacific Daylight Time	06/26/2015 08:21:13 AM Pacific Daylight Time				07/10/2015 03:23:28 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	2016	Portland-Vancouver Metro, Salem OR, Longview WA		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;16b;	1					2	2			
H9003	802	0	1	01	01	H9003_802_0	6		1	05/18/2015	2016.01	05/18/2015 01:25:08 PM Pacific Daylight Time	06/26/2015 08:21:59 AM Pacific Daylight Time				07/10/2015 03:23:28 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	2016	Portland-Vancouver Metro, Salem OR, Longview WA		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;14d;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;16b;	1					2	2			
H9003	805	0	1	01	01	H9003_805_0	6		1	05/18/2015	2016.01	05/18/2015 01:22:14 PM Pacific Daylight Time	06/26/2015 08:22:45 AM Pacific Daylight Time				07/10/2015 03:23:28 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	2016	Portland-Vancouver Metro, Salem OR, Longview WA		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;12;14d;15;16b;	1	1a;1b;2;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14d;16b;	1					2	2			
H9047	001	0	1	01	01	H9047_001_0	21		1	08/05/2015	2016.01	08/05/2015 01:01:29 PM Pacific Daylight Time	08/05/2015 02:20:15 PM Pacific Daylight Time	08/05/2015 10:49:10 AM Pacific Daylight Time			08/05/2015 04:20:47 PM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Extra + RX (HMO)	01	01		1			H9047	001	0	2016	Portland Metro, Willamette Valley, Clark County		2	173774	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	013	0	2	01	01	H9047_013_0	19		1	08/12/2015	2016.01	08/12/2015 07:50:06 AM Pacific Daylight Time	08/12/2015 09:17:12 AM Pacific Daylight Time	08/05/2015 10:49:37 AM Pacific Daylight Time			08/12/2015 09:20:57 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Extra Part B Only + RX (HMO)	01	01		2	2		H9047	013	0	2016	Portland Metro and Willamette Valley		2	4	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	024	0	1	02	01	H9047_024_0	16		1	08/05/2015	2016.01	08/05/2015 01:04:00 PM Pacific Daylight Time	08/05/2015 02:21:50 PM Pacific Daylight Time	08/05/2015 10:49:59 AM Pacific Daylight Time			08/05/2015 04:20:47 PM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Choice + RX (HMO-POS)	01	02		1			H9047	024	0	2016	Portland Metro, Willamette Valley, Clark County		2	184540	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(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	16		1	08/12/2015	2016.01	08/12/2015 07:50:27 AM Pacific Daylight Time	05/28/2015 03:32:45 PM Pacific Daylight Time				08/12/2015 08:11:56 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Extra (HMO)	01	01		1			H9047	033	0	2016	Portland Metro, Willamette Valley, Clark County		2	16278	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(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	14		1	08/12/2015	2016.01	08/12/2015 07:50:39 AM Pacific Daylight Time	05/28/2015 03:33:04 PM Pacific Daylight Time				08/12/2015 08:11:56 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Choice (HMO-POS)	01	02		1			H9047	035	0	2016	Portland Metro, Willamette Valley, Clark County		2	16397	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9047	037	0	1	02	01	H9047_037_0	20		1	08/05/2015	2016.01	08/05/2015 03:35:17 PM Pacific Daylight Time	08/05/2015 02:21:20 PM Pacific Daylight Time	08/05/2015 10:50:16 AM Pacific Daylight Time			08/05/2015 04:20:47 PM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Prime + RX (HMO-POS)	01	02		1			H9047	037	0	2016	Portland Metro		2	62461	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	038	0	1	02	01	H9047_038_0	17		1	08/05/2015	2016.01	08/05/2015 01:25:55 PM Pacific Daylight Time	08/05/2015 02:20:55 PM Pacific Daylight Time	08/05/2015 10:50:34 AM Pacific Daylight Time			08/05/2015 04:20:47 PM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Latitude + RX (HMO-POS)	01	02		1			H9047	038	0	2016	Central OR, Hood River		2	2396	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	039	0	1	02	01	H9047_039_0	19		1	08/05/2015	2016.01	08/05/2015 01:09:39 PM Pacific Daylight Time	08/05/2015 02:20:35 PM Pacific Daylight Time	08/05/2015 02:31:35 PM Pacific Daylight Time			08/05/2015 04:20:47 PM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Compass + RX (HMO-POS)	01	02		1			H9047	039	0	2016	Central OR, Hood River		2	2396	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(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	801	0	1	01	01	H9047_801_0	15		1	08/12/2015	2016.01	08/12/2015 07:52:04 AM Pacific Daylight Time	08/05/2015 10:52:27 AM Pacific Daylight Time				08/12/2015 08:11:56 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Align Group Plan (HMO)	01	01		1			H9047	801	0	2016	Portland Metro, Willamette Valley,Central OR,Clark		1	138200	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9047	804	0	1	01	01	H9047_804_0	14		1	08/12/2015	2016.01	08/12/2015 07:52:16 AM Pacific Daylight Time	08/05/2015 10:52:49 AM Pacific Daylight Time				08/12/2015 08:11:56 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Align Group Plan + RX (HMO)	01	01		1			H9047	804	0	2016	Portland Metro, Willamette Valley,Central OR,Clark		1	21301	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	805	0	1	02	01	H9047_805_0	14		1	08/12/2015	2016.01	08/12/2015 07:52:26 AM Pacific Daylight Time	08/05/2015 10:53:09 AM Pacific Daylight Time				08/12/2015 08:11:56 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Flex Group Plan + RX (HMO-POS)	01	02		1			H9047	805	0	2016	Portland Metro, Willamette Valley,Central OR,Clark		1	146	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	808	0	1	01	01	H9047_808_0	15		1	08/12/2015	2016.01	08/12/2015 07:52:55 AM Pacific Daylight Time	08/05/2015 10:53:30 AM Pacific Daylight Time				08/12/2015 08:11:56 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Align Group Plan (HMO)	01	01		1			H9047	808	0	2016	Portland Metro, Willamette Valley,Central OR,Clark		1		2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9047	809	0	1	02	01	H9047_809_0	15		1	08/12/2015	2016.01	08/12/2015 07:53:05 AM Pacific Daylight Time	08/05/2015 10:53:49 AM Pacific Daylight Time				08/12/2015 08:11:56 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Flex Group Plan (HMO-POS)	01	02		1			H9047	809	0	2016	Portland Metro, Willamette Valley,Central OR,Clark		1		2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(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			
H9068	001	0	1	20	08	H9068_001_0	3		1	05/28/2015	2016.01	05/28/2015 09:38:33 AM Eastern Daylight Time		05/28/2015 09:19:50 AM Eastern Daylight Time			05/28/2015 12:06:28 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE (PACE)	08	20		1			H9068	001	0	2016	Albright LIFE		2		2			2								www.albrightcare.org	www.albrightcare.org									(570)522-3880		(570)522-3880		(570)522-3880		(570)522-3880										(570)522-3880		(570)522-3880		(570)522-3880		(570)522-3880																
H9068	002	0	1	20	08	H9068_002_0	3		1	05/28/2015	2016.01	05/28/2015 09:39:02 AM Eastern Daylight Time		05/28/2015 09:20:02 AM Eastern Daylight Time			05/28/2015 12:06:28 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE Medicare Only (PACE)	08	20		1			H9068	002	0	2016	Albright LIFE		2		2			2								www.albrightcare.org	www.albrightcare.org									(570)522-3880		(570)522-3880		(570)522-3880		(570)522-3880										(570)522-3880		(570)522-3880		(570)522-3880		(570)522-3880																
H9082	007	0	1	01	01	H9082_007_0	7	2	1	08/05/2015	2016.01	08/05/2015 03:29:38 PM Pacific Daylight Time	08/06/2015 03:05:36 PM Pacific Daylight Time	07/30/2015 09:02:02 AM Pacific Daylight Time			08/06/2015 09:51:32 PM Pacific Daylight Time	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Molina Healthcare of New Mexico, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H9082	007	0	2016	New Mexico		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)440-0127		(866)440-0127		(866)403-8293		(866)403-8293		(866)440-0127		(866)440-0127		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	001	0	1	01	01	H9096_001_0	8		1	08/04/2015	2016.01	08/04/2015 05:25:33 PM Central Daylight Time	07/31/2015 04:45:40 PM Central Daylight Time	07/30/2015 04:03:08 PM Central Daylight Time			08/04/2015 05:57:39 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan	www.deancare.com/medicare	Dean Advantage Assurance (HMO)	01	01		1			H9096	001	0	2016	South Central Wisconsin		2		2			2							www.deancare.com/find-a-doc/	www.deancare.com	www.deancare.com	(888)422-3326		(608)828-1301		(888)422-3326		(608)828-1301		(888)422-3326		(608)828-1301		(888)422-3326		(608)828-1301		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	002	0	1	01	01	H9096_002_0	8		1	07/30/2015	2016.01	07/30/2015 03:31:26 PM Central Daylight Time	07/31/2015 04:47:30 PM Central Daylight Time	07/30/2015 04:03:50 PM Central Daylight Time			08/04/2015 05:57:39 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan	www.deancare.com/medicare	Dean Advantage Balance (HMO)	01	01		1			H9096	002	0	2016	South Central Wisconsin		2		2			2							www.deancare.com/find-a-doc/	www.deancare.com	www.deancare.com	(888)422-3326		(608)828-1301		(888)422-3326		(608)828-1301		(888)422-3326		(608)828-1301		(888)422-3326		(608)828-1301		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	003	0	1	02	01	H9096_003_0	12		1	07/30/2015	2016.01	07/30/2015 03:31:30 PM Central Daylight Time	07/31/2015 04:49:24 PM Central Daylight Time	07/30/2015 04:04:52 PM Central Daylight Time			08/04/2015 05:57:39 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan	www.deancare.com/medicare	Dean Advantage Confidence (HMO-POS)	01	02		1			H9096	003	0	2016	South Central Wisconsin		2		2			2							www.deancare.com/find-a-doc/	www.deancare.com	www.deancare.com	(888)422-3326		(608)828-1301		(888)422-3326		(608)828-1301		(888)422-3326		(608)828-1301		(888)422-3326		(608)828-1301		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9104	006	0	1	01	01	H9104_006_0	4		1	08/05/2015	2016.01	08/05/2015 11:34:46 AM Pacific Daylight Time	08/03/2015 01:49:42 PM Pacific Daylight Time	07/29/2015 02:00:30 PM Pacific Daylight Time			08/05/2015 03:13:42 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Healthy at Home (HMO SNP)	01	01		1			H9104	006	0	2016	Los Angeles, Orange, and Inland Empire Areas		2		2			1	1	2	1				www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9110	002	0	1	01	01	H9110_002_0	7		1	08/04/2015	2016.01	08/04/2015 11:00:52 AM Mountain Daylight Time	08/04/2015 03:12:30 PM Mountain Daylight Time	08/05/2015 04:28:24 PM Mountain Daylight Time			08/05/2015 04:55:59 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H9110	002	0	2016	Davis, Salt Lake, Utah, and Weber counties		2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9115	001	0	1	48	05	H9115_001_0	6		1	08/26/2015	2016.01	08/26/2015 12:47:23 PM Eastern Daylight Time					08/26/2015 12:48:32 PM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus FIDA	www.metroplusmedicare.org	MetroPlus FIDA (Medicare-Medicaid Plan)	05	48		1			H9115	001	0	2016	Kings, Queens, Bronx and New York Counties		2	818	2			2							www.metroplusmedicare.org	www.metroplus.org	www.caremark.com	(844)288-3432		(844)288-3432		(844)288-3432		(844)288-3432		(844)288-3432		(844)288-3432		(844)288-3432		(844)288-3432		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H9122	001	0	1	01	01	H9122_001_0	8		1	07/06/2015	2016.01	07/06/2015 01:57:22 PM Eastern Daylight Time	08/04/2015 01:00:38 PM Eastern Daylight Time	08/04/2015 01:29:46 PM Eastern Daylight Time			08/05/2015 02:00:54 PM Eastern Daylight Time	ALPHACARE OF NEW YORK, INC.	AlphaCare of New York, Inc.	www.alphacare.com/medicare	AlphaCare Renew (HMO)	01	01		1			H9122	001	0	2016	New York Metro Area		2		2			2								www.alphacare.com	www.alphacare.com	(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9122	002	0	1	01	01	H9122_002_0	8		1	08/04/2015	2016.01	08/04/2015 09:49:29 AM Eastern Daylight Time	08/04/2015 12:59:50 PM Eastern Daylight Time	08/04/2015 01:30:12 PM Eastern Daylight Time			08/05/2015 02:00:54 PM Eastern Daylight Time	ALPHACARE OF NEW YORK, INC.	AlphaCare of New York, Inc.	www.alphacare.com/medicare	AlphaCare Resilience (HMO SNP)	01	01		1			H9122	002	0	2016	New York Metro Area		2		2			1	1	1	1					www.alphacare.com	www.alphacare.com	(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9122	003	0	1	01	01	H9122_003_0	9	2	1	08/04/2015	2016.01	08/04/2015 09:49:43 AM Eastern Daylight Time	08/04/2015 12:59:34 PM Eastern Daylight Time	08/04/2015 01:30:00 PM Eastern Daylight Time			08/05/2015 02:00:54 PM Eastern Daylight Time	ALPHACARE OF NEW YORK, INC.	AlphaCare of New York, Inc.	www.alphacare.com/medicare	AlphaCare Total (HMO SNP)	01	01		1			H9122	003	0	2016	New York Metro Area		2		2			1	3		1	2				www.alphacare.com	www.alphacare.com	(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9162	001	0	1	01	01	H9162_001_0	7		1	08/05/2015	2016.01	08/05/2015 08:10:26 PM Central Daylight Time	08/05/2015 08:51:12 PM Central Daylight Time	08/05/2015 04:53:58 PM Central Daylight Time			08/05/2015 08:58:17 PM Central Daylight Time	CARESOURCE INDIANA, INC.	CareSource	CareSource..com	CareSource Advantage (HMO)	01	01		1			H9162	001	0	2016	Indiana		2	750	2			2							https://memberportal.caresource.com/App/Plans	http://caresource.com/	http://caresource.com/			(000)000-0000				(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		2					2					2	2			
H9162	002	0	1	01	01	H9162_002_0	6		1	07/09/2015	2016.01	07/09/2015 08:44:59 AM Central Daylight Time	08/05/2015 04:53:58 PM Central Daylight Time	08/05/2015 04:53:57 PM Central Daylight Time			08/05/2015 05:06:13 PM Central Daylight Time	CARESOURCE INDIANA, INC.	CareSource	CareSource..com	CareSource Advantage Plus (HMO)	01	01		1			H9162	002	0	2016	Indiana		2	750	2			2							https://memberportal.caresource.com/App/Plans	http://caresource.com/	http://caresource.com/			(000)000-0000				(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000		2					2					2	2			
H9185	001	0	1	20	08	H9185_001_0	1		1	05/21/2015	2016.01	05/21/2015 01:10:38 PM Eastern Daylight Time		05/21/2015 09:48:59 AM Eastern Daylight Time			05/21/2015 01:12:52 PM Eastern Daylight Time	A&D CHARITIBLE FOUNDATION, INC.	Great Lakes PACE	http://www.greatlakespace.org	Great Lakes PACE - Dual Eligible (PACE) (PACE)	08	20		1			H9185	001	0	2016	Great Lakes Bay Region: Saginaw, Midland, Bay, Tus		2		2			2								www.a-dhomecare.com	www.a-dhomecare.com									(844)445-7223		(989)249-0929		(844)445-7223		(989)249-0929										(771)-		(771)-		(771)-		(771)-																
H9185	002	0	1	20	08	H9185_002_0	1		1	05/21/2015	2016.01	05/21/2015 01:11:26 PM Eastern Daylight Time		05/21/2015 09:49:08 AM Eastern Daylight Time			05/21/2015 01:12:52 PM Eastern Daylight Time	A&D CHARITIBLE FOUNDATION, INC.	Great Lakes PACE	http://www.greatlakespace.org	Great Lakes PACE (PACE)	08	20		1			H9185	002	0	2016	Great Lakes Bay Region: Saginaw, Midland, Bay, Tus		2		2			2								www.a-dhomecare.com	www.a-dhomecare.com									(844)445-7223		(989)249-0929		(844)445-7223		(989)249-0929										(771)-		(771)-		(771)-		(771)-																
H9190	001	0	1	01	01	H9190_001_0	10	2	1	08/04/2015	2016.01	08/04/2015 11:31:47 AM Eastern Daylight Time	08/05/2015 03:03:01 PM Eastern Daylight Time	08/05/2015 03:03:01 PM Eastern Daylight Time			08/05/2015 03:28:12 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H9190	001	0	2016	Ohio Counties		2	1892	2			1	3		1	5			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	002	0	1	01	01	H9190_002_0	10	2	1	08/04/2015	2016.01	08/04/2015 11:31:33 AM Eastern Daylight Time	08/05/2015 03:03:02 PM Eastern Daylight Time	08/05/2015 03:03:02 PM Eastern Daylight Time			08/05/2015 03:30:54 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H9190	002	0	2016	Ohio Counties		2	367	2			1	3		1	4			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	003	0	1	01	01	H9190_003_0	12		1	08/04/2015	2016.01	08/04/2015 11:32:07 AM Eastern Daylight Time	08/05/2015 03:03:03 PM Eastern Daylight Time	08/05/2015 03:03:03 PM Eastern Daylight Time			08/05/2015 03:35:12 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Gold (HMO SNP)	01	01		1			H9190	003	0	2016	Ohio Counties		2	385	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	004	0	1	01	01	H9190_004_0	11		1	08/04/2015	2016.01	08/04/2015 11:32:30 AM Eastern Daylight Time	08/05/2015 03:03:03 PM Eastern Daylight Time	08/05/2015 03:03:03 PM Eastern Daylight Time			08/05/2015 03:38:24 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Platinum (HMO SNP)	01	01		1			H9190	004	0	2016	Ohio Counties		2	406	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	006	0	1	01	01	H9190_006_0	11		1	08/04/2015	2016.01	08/04/2015 11:32:48 AM Eastern Daylight Time	08/05/2015 03:03:03 PM Eastern Daylight Time	08/05/2015 03:03:04 PM Eastern Daylight Time			08/05/2015 03:42:45 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Prime (HMO)	01	01		1			H9190	006	0	2016	Ohio Counties		2	352	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	007	0	1	01	01	H9190_007_0	11	2	1	08/04/2015	2016.01	08/04/2015 11:33:08 AM Eastern Daylight Time	08/05/2015 03:03:04 PM Eastern Daylight Time	08/05/2015 03:03:04 PM Eastern Daylight Time			08/05/2015 03:46:14 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H9190	007	0	2016	North Carolina Counties		2	1239	2			1	3		1	5			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	008	0	1	01	01	H9190_008_0	10	2	1	08/04/2015	2016.01	08/04/2015 11:33:24 AM Eastern Daylight Time	08/05/2015 03:03:04 PM Eastern Daylight Time	08/05/2015 03:03:06 PM Eastern Daylight Time			08/05/2015 03:49:05 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H9190	008	0	2016	North Carolina Counties		2	83	2			1	3		1	4			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	009	0	1	01	01	H9190_009_0	11		1	08/04/2015	2016.01	08/04/2015 11:33:45 AM Eastern Daylight Time	08/05/2015 03:03:06 PM Eastern Daylight Time	08/05/2015 03:03:07 PM Eastern Daylight Time			08/05/2015 03:52:04 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Gold (HMO SNP)	01	01		1			H9190	009	0	2016	North Carolina Counties		2	283	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	010	0	1	01	01	H9190_010_0	12		1	08/04/2015	2016.01	08/04/2015 11:34:19 AM Eastern Daylight Time	08/05/2015 03:03:07 PM Eastern Daylight Time	08/05/2015 03:03:08 PM Eastern Daylight Time			08/05/2015 04:16:26 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Platinum (HMO SNP)	01	01		1			H9190	010	0	2016	North Carolina Counties		2	113	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	012	0	1	01	01	H9190_012_0	11		1	08/04/2015	2016.01	08/04/2015 11:34:37 AM Eastern Daylight Time	08/05/2015 03:03:08 PM Eastern Daylight Time	08/05/2015 03:03:08 PM Eastern Daylight Time			08/05/2015 03:57:57 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Prime (HMO)	01	01		1			H9190	012	0	2016	North Carolina Counties		2	65	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	013	0	1	01	01	H9190_013_0	10	2	1	08/04/2015	2016.01	08/04/2015 11:34:54 AM Eastern Daylight Time	08/05/2015 03:03:09 PM Eastern Daylight Time	08/05/2015 03:03:10 PM Eastern Daylight Time			08/05/2015 04:07:24 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H9190	013	0	2016	Kentucky Counties		2	561	2			1	3		1	5			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	014	0	1	01	01	H9190_014_0	10	2	1	08/04/2015	2016.01	08/04/2015 11:35:09 AM Eastern Daylight Time	08/05/2015 03:03:11 PM Eastern Daylight Time	08/05/2015 03:03:11 PM Eastern Daylight Time			08/05/2015 04:10:24 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H9190	014	0	2016	Kentucky Counties		2	71	2			1	3		1	4			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	015	0	1	01	01	H9190_015_0	12		1	08/04/2015	2016.01	08/04/2015 11:35:28 AM Eastern Daylight Time	08/05/2015 06:26:29 PM Eastern Daylight Time	08/05/2015 06:26:28 PM Eastern Daylight Time			08/05/2015 06:31:00 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Gold (HMO SNP)	01	01		1			H9190	015	0	2016	Kentucky Counties		2	167	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	016	0	1	01	01	H9190_016_0	11		1	08/04/2015	2016.01	08/04/2015 11:35:51 AM Eastern Daylight Time	08/05/2015 03:03:12 PM Eastern Daylight Time	08/05/2015 03:03:13 PM Eastern Daylight Time			08/05/2015 04:22:57 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Platinum (HMO SNP)	01	01		1			H9190	016	0	2016	Kentucky Counties		2	204	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	018	0	1	01	01	H9190_018_0	11		1	08/04/2015	2016.01	08/04/2015 11:36:09 AM Eastern Daylight Time	08/05/2015 03:03:14 PM Eastern Daylight Time	08/05/2015 03:03:14 PM Eastern Daylight Time			08/05/2015 04:26:50 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Prime (HMO)	01	01		1			H9190	018	0	2016	Kentucky Counties		2	125	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	019	0	1	01	01	H9190_019_0	12		1	08/04/2015	2016.01	08/04/2015 11:36:24 AM Eastern Daylight Time	08/05/2015 03:03:15 PM Eastern Daylight Time	08/05/2015 03:03:16 PM Eastern Daylight Time			08/05/2015 04:31:16 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Select (HMO)	01	01		1			H9190	019	0	2016	Ohio Counties		2	2158	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	020	0	1	01	01	H9190_020_0	11		1	08/04/2015	2016.01	08/04/2015 11:36:37 AM Eastern Daylight Time	08/05/2015 03:03:17 PM Eastern Daylight Time	08/05/2015 03:03:18 PM Eastern Daylight Time			08/05/2015 04:34:04 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Select (HMO)	01	01		1			H9190	020	0	2016	North Carolina Counties		2	1378	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6430		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	021	0	1	01	01	H9190_021_0	11		1	08/04/2015	2016.01	08/04/2015 11:36:53 AM Eastern Daylight Time	08/05/2015 03:03:19 PM Eastern Daylight Time	08/05/2015 03:03:20 PM Eastern Daylight Time			08/05/2015 04:38:17 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Select (HMO)	01	01		1			H9190	021	0	2016	Kentucky Counties		2	1436	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(855)847-6380		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	801	0	1	01	01	H9190_801_0	1		1	05/31/2015	2016.01	05/31/2015 11:02:48 AM Eastern Daylight Time	05/31/2015 06:28:00 AM Eastern Daylight Time				05/31/2015 11:05:16 AM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.MedicareAssured.com	Gateway Health Medicare Assured Flex (HMO)	01	01		1			H9190	801	0	2016	Kentucky, North Carolina and Ohio counties		1	14	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9190	802	0	1	01	01	H9190_802_0	1		1	05/31/2015	2016.01	05/31/2015 11:03:39 AM Eastern Daylight Time	05/31/2015 06:28:00 AM Eastern Daylight Time				05/31/2015 11:06:53 AM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.MedicareAssured.com	Gateway Health Medicare Assured Flex (HMO)	01	01		1			H9190	802	0	2016	Kentucky, North Carolina and Ohio counties		1	14	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	001	0	1	01	01	H9207_001_0	6		1	07/06/2015	2016.01	07/06/2015 08:06:26 AM Eastern Daylight Time	07/28/2015 11:16:33 AM Eastern Daylight Time				07/28/2015 11:29:41 AM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Basic (HMO)	01	01		1			H9207	001	0	2016	Philadelphia, Bucks, Chester, Delaware, Montgomery		2	122	2			2							HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9207	002	0	1	01	01	H9207_002_0	8		1	07/06/2015	2016.01	07/06/2015 09:23:39 AM Eastern Daylight Time	07/28/2015 11:16:33 AM Eastern Daylight Time	06/01/2015 06:55:51 PM Eastern Daylight Time			07/28/2015 11:29:41 AM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Prime (HMO)	01	01		1			H9207	002	0	2016	Philadelphia County		2	6038	2			2							HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	003	0	1	01	01	H9207_003_0	7		1	07/06/2015	2016.01	07/06/2015 09:23:53 AM Eastern Daylight Time	07/28/2015 11:16:33 AM Eastern Daylight Time	06/01/2015 06:55:46 PM Eastern Daylight Time			07/28/2015 11:29:41 AM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare PrimePlus (HMO)	01	01		1			H9207	003	0	2016	Philadelphia County		2	1409	2			2							HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	004	0	1	01	01	H9207_004_0	8	2	1	07/07/2015	2016.01	07/07/2015 10:03:50 AM Eastern Daylight Time	08/05/2015 09:37:18 AM Eastern Daylight Time	08/05/2015 09:37:18 AM Eastern Daylight Time			08/06/2015 06:05:24 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Special (HMO SNP)	01	01		1			H9207	004	0	2016	Philadelphia, Bucks, Chester, Delaware, Montgomery		2	14937	2			1	3		1	2			HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	005	0	1	01	01	H9207_005_0	8		1	07/06/2015	2016.01	07/06/2015 09:24:04 AM Eastern Daylight Time	07/28/2015 11:16:33 AM Eastern Daylight Time	06/01/2015 06:55:48 PM Eastern Daylight Time			07/28/2015 11:29:41 AM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Prime (HMO)	01	01		1			H9207	005	0	2016	Bucks, Chester, Delaware and Montgomery Counties		2	1608	2			2							HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	006	0	1	01	01	H9207_006_0	7		1	07/06/2015	2016.01	07/06/2015 09:24:30 AM Eastern Daylight Time	07/28/2015 11:16:33 AM Eastern Daylight Time	06/01/2015 06:55:49 PM Eastern Daylight Time			07/28/2015 11:29:41 AM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare PrimePlus (HMO)	01	01		1			H9207	006	0	2016	Bucks, Chester, Delaware and Montgomery Counties		2	300	2			2							HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9208	001	0	1	01	01	H9208_001_0	5		1	07/13/2015	2016.01	07/13/2015 08:36:51 AM Central Daylight Time	07/29/2015 04:16:14 PM Central Daylight Time	07/29/2015 02:08:36 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	RIVERLINK HEALTH	RiverLink Health	www.riverlinkhealth.com	Classic Plus Rx (HMO)	01	01		1			H9208	001	0	2016	Butler, Clermont, Hamilton and Warren Counties		2	1842	2			2							www.riverlinkhealth.com	www.riverlinkhealth.com	www.riverlinkhealth.com	(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9208	002	0	1	01	01	H9208_002_0	5		1	07/13/2015	2016.01	07/13/2015 08:39:56 AM Central Daylight Time	07/29/2015 04:16:00 PM Central Daylight Time	07/29/2015 02:09:00 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	RIVERLINK HEALTH	RiverLink Health	www.riverlinkhealth.com	Classic Plus Rx - N Kentucky (HMO)	01	01		1			H9208	002	0	2016	Boone, Campbell and Kenton Counties		2	1189	2			2							www.riverlinkhealth.com	www.riverlinkhealth.com	www.riverlinkhealth.com	(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(866)329-3970		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9266	001	0	1	20	08	H9266_001_0	1		1	05/29/2015	2016.01	05/29/2015 08:19:33 AM Eastern Daylight Time		05/28/2015 01:54:03 PM Eastern Daylight Time			05/29/2015 08:21:53 AM 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	2016	Piedmont Region of NC		2		2			2								no answer	no answer									(877)714-2100		(336)532-0000		(877)714-2100		(336)532-0000										(877)714-2100		(336)532-0000		(877)714-2100		(336)532-0000																
H9266	003	0	1	20	08	H9266_003_0	1		1	05/29/2015	2016.01	05/29/2015 08:19:58 AM Eastern Daylight Time		05/28/2015 01:55:06 PM Eastern Daylight Time			05/29/2015 08:21:53 AM 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	2016	Piedmont Region of NC		2		2			2								no answer	no answer									(877)714-2100		(336)532-0000		(877)714-2100		(336)532-0000										(877)714-2100		(336)532-0000		(877)714-2100		(336)532-0000																
H9285	001	0	1	01	01	H9285_001_0	6		1	08/05/2015	2016.01	08/05/2015 01:59:20 PM Eastern Daylight Time	08/05/2015 11:33:28 AM Eastern Daylight Time	08/04/2015 03:00:29 PM Eastern Daylight Time			08/05/2015 02:06:22 PM Eastern Daylight Time	ATLANTIS HEALTH PLAN, INC.	EASY CHOICE HEALTH PLAN OF NEW YORK	www.EasyChoiceNY.com	Easy Choice Rewards (HMO)	01	01		1			H9285	001	0	2016	Select Counties in New York		2	0	2			2							www.EasyChoiceNY.com	www.EasyChoiceNY.com	www.EasyChoiceNY.com	(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9285	003	0	1	01	01	H9285_003_0	7		1	08/05/2015	2016.01	08/05/2015 08:28:14 AM Eastern Daylight Time	08/04/2015 03:11:16 PM Eastern Daylight Time	08/04/2015 03:02:40 PM Eastern Daylight Time			08/05/2015 08:30:37 AM Eastern Daylight Time	ATLANTIS HEALTH PLAN, INC.	EASY CHOICE HEALTH PLAN OF NEW YORK	www.EasyChoiceNY.com	Easy Choice Diamond Rewards (HMO SNP)	01	01		1			H9285	003	0	2016	Select Counties in New York		2	0	2			1	4		1		00000000000000000010		www.EasyChoiceNY.com	www.EasyChoiceNY.com	www.EasyChoiceNY.com	(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9302	003	0	1	01	01	H9302_003_0	6		1	07/17/2015	2016.01	07/17/2015 05:06:06 PM Central Daylight Time	08/03/2015 10:27:42 AM Central Daylight Time	07/29/2015 02:10:08 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.soundpathhealth.com	Soundpath Health Charter + Rx (HMO)	01	01		1			H9302	003	0	2016	Western and Central Washington areas		2	2236	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9302	004	0	1	01	01	H9302_004_0	4		1	07/17/2015	2016.01	07/17/2015 05:06:18 PM Central Daylight Time	07/16/2015 05:57:08 PM Central Daylight Time				07/17/2015 05:46:10 PM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.soundpathhealth.com	Soundpath Health Alpine (HMO)	01	01		1			H9302	004	0	2016	Western and Central Washington areas		2	684	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9302	007	0	1	01	01	H9302_007_0	7		1	07/17/2015	2016.01	07/17/2015 05:06:26 PM Central Daylight Time	08/03/2015 10:03:10 AM Central Daylight Time	07/29/2015 02:49:02 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.soundpathhealth.com	Soundpath Health Sound + Rx (HMO)	01	01		1			H9302	007	0	2016	Western Washington areas		2	10086	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9302	011	0	1	01	01	H9302_011_0	6		1	07/17/2015	2016.01	07/17/2015 05:15:11 PM Central Daylight Time	08/03/2015 09:59:46 AM Central Daylight Time	07/29/2015 02:49:12 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.soundpathhealth.com	Soundpath Health Peak + Rx (HMO)	01	01		1			H9302	011	0	2016	Western and Central Washington areas		2	14780	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9302	801	0	1	01	01	H9302_801_0	2		1	05/31/2015	2016.01	05/31/2015 01:30:47 PM Central Daylight Time	06/01/2015 02:05:40 PM Central Daylight Time				06/01/2015 03:00:30 PM Central Daylight Time	SOUNDPATH HEALTH	Soundpath Health	www.soundpathhealth.com.	Soundpath Health + Rx (HMO)	01	01		1			H9302	801	0	2016	Western and Central Washington areas		1	9	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9312	001	0	1	04	01	H9312_001_0	6		1	08/04/2015	2016.01	08/04/2015 12:15:38 PM Central Daylight Time		08/04/2015 01:54:42 PM Central Daylight Time		08/04/2015 03:20:03 PM Central Daylight Time	08/04/2015 03:29:01 PM Central Daylight Time	ONENATION INSURANCE COMPANY	Fresenius Health Plans	www.esrdplan.com	Fresenius Total Health (PPO SNP)	01	04		1			H9312	001	0	2016	Maricopa County		2	95	2			1	4		1		00000000100000000000		www.esrdplan.com	www.esrdplan.com	www.esrdplan.com	(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		2					2						2			
H9312	002	0	1	04	01	H9312_002_0	5		1	07/09/2015	2016.01	07/09/2015 01:10:50 PM Central Daylight Time		06/01/2015 07:50:39 PM Central Daylight Time		06/01/2015 07:48:44 PM Central Daylight Time	07/09/2015 01:48:51 PM Central Daylight Time	ONENATION INSURANCE COMPANY	Fresenius Health Plans	www.esrdplan.com	Fresenius Total Health (PPO SNP)	01	04		1			H9312	002	0	2016	San Diego County		2	95	2			1	4		1		00000000100000000000		www.esrdplan.com	www.esrdplan.com	www.esrdplan.com	(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(855)598-6774		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		(844)209-9094		2					2						2			
H9345	001	0	1	48	05	H9345_001_0	7		1	08/13/2015	2016.01	08/13/2015 04:08:12 PM Eastern Daylight Time					08/13/2015 04:09:46 PM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX Full Advantage FIDA	www.villagecaremax.org	VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)	05	48		1			H9345	001	0	2016	Kings, Queens, Bronx, New York		2	720	2			2							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				
H9412	003	0	1	04	01	H9412_003_0	8		1	07/13/2015	2016.01	07/13/2015 02:02:19 PM Eastern Daylight Time	08/04/2015 12:19:31 PM Eastern Daylight Time	08/04/2015 12:19:31 PM Eastern Daylight Time			08/04/2015 08:29:52 PM Eastern Daylight Time	GEISINGER QUALITY OPTIONS, INC.	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Preferred Rx (PPO)	01	04		1			H9412	003	0	2016	Monmouth and Ocean Counties, New Jersey		2		2			2							www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376		(800)988-4861		(570)271-5673		(800)419-1376		(800)419-1376		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9460	001	0	1	01	01	H9460_001_0	5		1	07/09/2015	2016.01	07/09/2015 04:44:08 PM Central Daylight Time	08/01/2015 09:41:10 AM Central Daylight Time	07/30/2015 08:34:11 AM Central Daylight Time			08/03/2015 09:09:24 PM Central Daylight Time	CIGNA HEALTHCARE OF ST LOUIS, INC.	Cigna-HealthSpring	www.cignahealthspring.com	Cigna Preferred (HMO)	01	01		1			H9460	001	0	2016	Kansas City		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9487	001	0	1	48	05	H9487_001_0	6		1	08/27/2015	2016.01	08/27/2015 09:45:10 AM Central Daylight Time					08/27/2015 04:49:07 PM Central Daylight Time	FIDELIS SECURECARE OF MICHIGAN	Fidelis SecureCare of Michigan	http://www.fidelissc.com/our-plans/mmp	Fidelis SecureLife (Medicare-Medicaid Plan)	05	48		1			H9487	001	0	2016	Selected Michigan Counties		2	3300	2			2							http://fidelissc.com/2015/our-plans/mmp/search-for-a-provider/	http://fidelissc.com/2015/our-plans/mmp/prescription-drug-part-d-list-of-drugs/	http://fidelissc.com/2015/our-plans/mmp/find-a-pharmacy/	(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H9492	001	0	1	02	01	H9492_001_0	4		1	07/13/2015	2016.01	07/13/2015 08:51:02 AM Central Daylight Time	07/29/2015 04:15:46 PM Central Daylight Time	07/29/2015 02:10:40 PM Central Daylight Time			08/03/2015 04:23:13 PM Central Daylight Time	STABLEVIEW HEALTH	StableView Health	www.stableviewhealth.com	Classic Plus Rx (HMO-POS)	01	02		1			H9492	001	0	2016	Lexington Metropolitan Area		2	528	2			2							www.stableviewhealth.com	www.stableviewhealth.com	www.stableviewhealth.com	(866)792-0180		(866)792-0180		(866)792-0180		(866)792-0180		(866)792-0180		(866)792-0180		(866)792-0180		(866)792-0180		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	003	0	1	01	01	H9525_003_0	8	2	1	07/06/2015	2016.01	07/06/2015 04:17:12 PM Eastern Daylight Time	08/01/2015 09:52:38 PM Eastern Daylight Time	07/30/2015 07:34:46 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H9525	003	0	2016	Wisconsin		2	809	2			1	3		1	5				www.anthem.com/medicare	www.anthem.com/medicare	(855)304-1774		(855)304-1774		(844)316-0358		(844)316-0358		(855)304-1774		(855)304-1774		(844)316-0358		(844)316-0358		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	004	0	1	01	01	H9525_004_0	8		1	07/16/2015	2016.01	07/16/2015 04:21:11 PM Eastern Daylight Time	08/03/2015 04:17:40 PM Eastern Daylight Time	07/30/2015 06:40:03 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	004	0	2016	Milwaukee and Waukesha		2	1857	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)304-1774		(855)304-1774		(844)364-2130		(844)364-2130		(855)304-1774		(855)304-1774		(844)373-7115		(844)373-7115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	005	0	1	01	01	H9525_005_0	8		1	07/16/2015	2016.01	07/16/2015 04:21:28 PM Eastern Daylight Time	08/03/2015 04:18:15 PM Eastern Daylight Time	07/30/2015 06:40:40 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	005	0	2016	Kenosha		2	380	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)304-1774		(855)304-1774		(844)364-2130		(844)364-2130		(855)304-1774		(855)304-1774		(844)373-7115		(844)373-7115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	006	0	1	01	01	H9525_006_0	8		1	08/03/2015	2016.01	08/03/2015 01:28:14 PM Eastern Daylight Time	08/03/2015 04:18:51 PM Eastern Daylight Time	07/30/2015 06:29:37 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9525	006	0	2016	Green Bay Area		2	934	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)304-1774		(855)304-1774		(844)364-2130		(844)364-2130		(855)304-1774		(855)304-1774		(844)373-7115		(844)373-7115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	801	0	1	01	01	H9525_801_0	4		1	05/20/2015	2016.01	05/20/2015 11:30:53 AM Pacific Daylight Time	05/31/2015 03:04:07 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H9525	801	0	2016	Wisconsin select counties		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H9525	802	0	1	01	01	H9525_802_0	4		1	05/20/2015	2016.01	05/20/2015 11:30:57 AM Pacific Daylight Time	05/31/2015 03:04:12 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H9525	802	0	2016	Select counties in Wisconsin		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H9572	001	1	1	04	01	H9572_001_1	7		1	07/14/2015	2016.01	07/14/2015 08:42:45 AM Eastern Daylight Time	08/03/2015 02:26:08 PM Eastern Daylight Time	07/30/2015 02:55:27 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 1	2	1707	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	2	1	04	01	H9572_001_2	7		1	07/14/2015	2016.01	07/14/2015 08:42:52 AM Eastern Daylight Time	08/03/2015 02:26:29 PM Eastern Daylight Time	07/30/2015 03:06:40 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 2	2	4031	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	3	1	04	01	H9572_001_3	7		1	07/14/2015	2016.01	07/14/2015 08:35:33 AM Eastern Daylight Time	08/03/2015 02:26:50 PM Eastern Daylight Time	07/30/2015 02:56:57 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 3	2	4667	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	4	1	04	01	H9572_001_4	7		1	07/14/2015	2016.01	07/14/2015 08:29:10 AM Eastern Daylight Time	08/03/2015 02:27:12 PM Eastern Daylight Time	07/30/2015 02:57:11 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 4	2	8197	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	001	6	1	04	01	H9572_001_6	6		1	07/14/2015	2016.01	07/14/2015 08:29:20 AM Eastern Daylight Time	08/03/2015 02:27:33 PM Eastern Daylight Time	07/30/2015 02:57:26 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 6	2	25941	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	1	1	04	01	H9572_002_1	7		1	07/14/2015	2016.01	07/14/2015 08:43:05 AM Eastern Daylight Time	08/03/2015 02:32:23 PM Eastern Daylight Time	07/30/2015 02:57:40 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 1	2	654	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	2	1	04	01	H9572_002_2	7		1	07/14/2015	2016.01	07/14/2015 08:43:13 AM Eastern Daylight Time	08/03/2015 02:28:16 PM Eastern Daylight Time	07/30/2015 02:57:55 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 2	2	1590	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	3	1	04	01	H9572_002_3	7		1	07/14/2015	2016.01	07/14/2015 08:29:50 AM Eastern Daylight Time	08/03/2015 02:28:38 PM Eastern Daylight Time	07/30/2015 02:58:09 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 3	2	1414	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	4	1	04	01	H9572_002_4	7		1	07/14/2015	2016.01	07/14/2015 08:33:43 AM Eastern Daylight Time	08/03/2015 02:29:00 PM Eastern Daylight Time	07/30/2015 02:58:24 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 4	2	3044	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	002	6	1	04	01	H9572_002_6	7		1	07/14/2015	2016.01	07/14/2015 08:30:11 AM Eastern Daylight Time	08/03/2015 02:29:21 PM Eastern Daylight Time	07/30/2015 02:58:39 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 6	2	3739	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	1	1	04	01	H9572_003_1	7		1	07/14/2015	2016.01	07/14/2015 08:43:26 AM Eastern Daylight Time	08/03/2015 02:29:42 PM Eastern Daylight Time	07/30/2015 02:58:55 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 1	2	899	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	2	1	04	01	H9572_003_2	7		1	07/14/2015	2016.01	07/14/2015 08:43:36 AM Eastern Daylight Time	08/03/2015 02:31:42 PM Eastern Daylight Time	07/30/2015 02:59:09 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 2	2	1678	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	3	1	04	01	H9572_003_3	7		1	07/14/2015	2016.01	07/14/2015 08:30:45 AM Eastern Daylight Time	08/03/2015 02:32:45 PM Eastern Daylight Time	07/30/2015 02:59:25 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 3	2	1098	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	4	1	04	01	H9572_003_4	7		1	07/14/2015	2016.01	07/14/2015 08:30:54 AM Eastern Daylight Time	08/03/2015 02:33:06 PM Eastern Daylight Time	07/30/2015 02:59:37 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 4	2	2993	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	003	6	1	04	01	H9572_003_6	7		1	07/14/2015	2016.01	07/14/2015 08:31:04 AM Eastern Daylight Time	08/03/2015 02:33:27 PM Eastern Daylight Time	07/30/2015 02:59:51 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 6	2	5541	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	1	1	04	01	H9572_004_1	7		1	07/22/2015	2016.01	07/22/2015 11:03:16 AM Eastern Daylight Time	08/03/2015 02:33:49 PM Eastern Daylight Time	07/30/2015 03:00:07 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 1	2	232	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	2	1	04	01	H9572_004_2	7		1	07/22/2015	2016.01	07/22/2015 11:03:11 AM Eastern Daylight Time	08/03/2015 02:49:47 PM Eastern Daylight Time	07/30/2015 03:00:23 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 2	2	1081	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	3	1	04	01	H9572_004_3	7		1	07/22/2015	2016.01	07/22/2015 11:03:07 AM Eastern Daylight Time	08/03/2015 02:50:08 PM Eastern Daylight Time	07/30/2015 03:00:38 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 3	2	1287	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	4	1	04	01	H9572_004_4	7		1	07/22/2015	2016.01	07/22/2015 11:03:03 AM Eastern Daylight Time	08/03/2015 02:50:39 PM Eastern Daylight Time	07/30/2015 03:00:53 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 4	2	3000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	004	6	1	04	01	H9572_004_6	7		1	07/22/2015	2016.01	07/22/2015 11:02:59 AM Eastern Daylight Time	08/03/2015 02:50:57 PM Eastern Daylight Time	07/30/2015 03:01:07 PM Eastern Daylight Time			08/04/2015 02:35:34 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	2016	State of Michigan	Region 6	2	3895	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	801	0	1	04	01	H9572_801_0	3		1	05/21/2015	2016.01	05/21/2015 01:09:37 PM Eastern Daylight Time	06/01/2015 06:51:29 PM Eastern Daylight Time				06/01/2015 08:38:44 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer Rx CY (PPO)	01	04		1			H9572	801	0	2016	State of Michigan		1	13000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9c;	2		1						2			
H9572	802	0	1	04	01	H9572_802_0	3		1	05/21/2015	2016.01	05/21/2015 01:09:45 PM Eastern Daylight Time	06/01/2015 06:52:11 PM Eastern Daylight Time				06/01/2015 08:38:44 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer CY (PPO)	01	04		1			H9572	802	0	2016	State of Michigan		1	121000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9c;	2		1						2			
H9572	803	0	1	04	01	H9572_803_0	4		1	05/22/2015	2016.01	05/22/2015 09:07:21 AM Eastern Daylight Time	07/13/2015 02:54:37 PM Eastern Daylight Time				07/17/2015 07:29:50 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	2016	State of Michigan		1	13000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9c;	2		1						2			
H9572	804	0	1	04	01	H9572_804_0	4		1	05/21/2015	2016.01	05/21/2015 01:09:58 PM Eastern Daylight Time	07/13/2015 02:55:27 PM Eastern Daylight Time				07/17/2015 07:29:50 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	2016	State of Michigan		1	13000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9c;	2		1						2			
H9572	805	0	1	04	01	H9572_805_0	4		1	05/29/2015	2016.01	05/29/2015 01:09:27 PM Eastern Daylight Time	06/01/2015 06:54:17 PM Eastern Daylight Time				06/01/2015 08:38:44 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer CY ASC (PPO)	01	04		1			H9572	805	0	2016	State of Michigan		1	108000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(877)241-2583		(877)241-2583										(771)-		(771)-		(771)-		(771)-										1	1	1a;1b;2;5;7e;7h;8a;8b1;8b2;9c;	2		1						2			
H9585	001	0	1	01	01	H9585_001_0	11	2	1	08/10/2015	2016.01	08/10/2015 09:09:26 AM Eastern Daylight Time	08/10/2015 12:34:42 PM Eastern Daylight Time	07/29/2015 02:07:02 PM Eastern Daylight Time			08/10/2015 01:18:44 PM Eastern Daylight Time	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Boston Medical Center HealthNet Plan	www.bmchp.org	Boston Medical Center HealthNet Plan (HMO SNP)	01	01		1			H9585	001	0	2016	Boston Medical Center HealthNet Plan		2		2			1	3		1	5			www.bmchp.org	www.bmchp.org\pharmacy	www.bmchp.org\pharmacy	(888)566-0010		(888)566-0010		(888)566-0010		(888)566-0010		(888)566-0010		(888)566-0010		(888)566-0010		(888)566-0010		(866)765-0055		(866)765-0055		(866)765-0055		(866)765-0055		(866)765-0055		(866)765-0055		(866)765-0055		(866)765-0055		2					2					2	2			
H9592	001	0	1	20	08	H9592_001_0	1		1	05/20/2015	2016.01	05/20/2015 09:43:15 AM Pacific Daylight Time		05/18/2015 09:15:39 AM Pacific Daylight Time			05/20/2015 09:45:03 AM Pacific Daylight Time	CENTRAL VALLEY MEDICAL SERVICES CORPORATION	Fresno PACE	www.fresnopace.org	Central Valley Medical Services Dual Eligible (PACE)	08	20		1			H9592	001	0	2016	Fresno County Area		2		2			2								www.pharmastarpbm.com/	www.fresnopace.org									(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	05/20/2015	2016.01	05/20/2015 09:43:46 AM Pacific Daylight Time		05/18/2015 09:19:14 AM Pacific Daylight Time			05/20/2015 09:45:03 AM Pacific Daylight Time	CENTRAL VALLEY MEDICAL SERVICES CORPORATION	Fresno PACE	www.fresnopace.org	Central Valley Medical Services Medicare only (PACE)	08	20		1			H9592	002	0	2016	Fresno County Area		2		2			2								www.pharmastarpbm.com/	www.fresnopace.org									(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223										(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223																
H9615	007	0	1	04	01	H9615_007_0	9		1	07/24/2015	2016.01	07/24/2015 04:34:49 PM Eastern Daylight Time	08/04/2015 07:21:47 AM Eastern Daylight Time	08/04/2015 07:22:03 AM Eastern Daylight Time			08/04/2015 08:54:33 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Gold PPO with Part D (PPO)	01	04		1			H9615	007	0	2016	Western NY, Central NY, Eastern NY, Western VT		2	5333	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(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			
H9615	008	0	1	04	01	H9615_008_0	13		1	07/24/2015	2016.01	07/24/2015 04:34:59 PM Eastern Daylight Time	08/04/2015 07:22:11 AM Eastern Daylight Time	08/04/2015 07:25:00 AM Eastern Daylight Time			08/04/2015 08:54:33 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	BasiCare with Part D (PPO)	01	04		1			H9615	008	0	2016	Western NY, Central NY, Eastern NY, Western VT		2	2643	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(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			
H9615	009	0	1	04	01	H9615_009_0	10		1	07/24/2015	2016.01	07/24/2015 04:35:11 PM Eastern Daylight Time	08/04/2015 07:22:20 AM Eastern Daylight Time	08/04/2015 09:18:06 AM Eastern Daylight Time			08/04/2015 09:25:09 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Gold PPO with Part D (PPO)	01	04		1			H9615	009	0	2016	Hudson Valley		2	200	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(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			
H9615	010	0	1	04	01	H9615_010_0	9		1	07/24/2015	2016.01	07/24/2015 04:35:20 PM Eastern Daylight Time	08/04/2015 07:22:27 AM Eastern Daylight Time	08/04/2015 07:22:35 AM Eastern Daylight Time			08/04/2015 08:54:33 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	BasiCare with Part D (PPO)	01	04		1			H9615	010	0	2016	Hudson Valley		2	200	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(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			
H9615	802	0	1	04	01	H9615_802_0	3		1	05/28/2015	2016.01	05/28/2015 02:33:43 PM Eastern Daylight Time	06/01/2015 11:41:26 PM Eastern Daylight Time				06/02/2015 12:00:55 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	GoldAnywhere Rx - Employer Group (PPO)	01	04		1			H9615	802	0	2016	Employer Group East/West		1	10296	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H9615	807	0	1	04	01	H9615_807_0	6		1	05/28/2015	2016.01	05/28/2015 07:25:37 AM Eastern Daylight Time	07/15/2015 04:37:38 PM Eastern Daylight Time				07/15/2015 04:51:50 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	USA Care Rx - Employer Group (PPO)	01	04		1			H9615	807	0	2016	United States and Puerto Rico		1	1241	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(888)597-4419		(888)597-4419		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H9615	810	0	1	04	01	H9615_810_0	3		1	05/28/2015	2016.01	05/28/2015 07:26:22 AM Eastern Daylight Time	06/01/2015 11:41:32 PM Eastern Daylight Time				06/02/2015 12:00:55 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	GoldAnywhere - Employer Group (PPO)	01	04		1			H9615	810	0	2016	Western NY, Central NY, Eastern NY, Western VT		1	250	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H9615	811	0	1	04	01	H9615_811_0	6		1	05/27/2015	2016.01	05/27/2015 03:54:21 PM Eastern Daylight Time	07/15/2015 04:37:38 PM Eastern Daylight Time				07/15/2015 04:51:50 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	USA Care without Part D - Employer Group (PPO)	01	04		1			H9615	811	0	2016	United States and Puerto Rico		1	30	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1						2			
H9616	001	0	1	20	08	H9616_001_0	1		1	05/26/2015	2016.01	05/26/2015 12:46:52 PM Pacific Daylight Time		05/21/2015 10:39:36 AM Pacific Daylight Time			05/26/2015 12:50:05 PM Pacific Daylight Time	SAN YSIDRO HEALTH CENTER	San Diego PACE	http://www.syhc.org/sdpace/	San Diego PACE (Duals) (PACE)	08	20		1			H9616	001	0	2016	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	05/26/2015	2016.01	05/26/2015 12:47:50 PM Pacific Daylight Time		05/21/2015 10:40:04 AM Pacific Daylight Time			05/26/2015 12:50:05 PM Pacific Daylight Time	SAN YSIDRO HEALTH CENTER	San Diego PACE	http://www.syhc.org/sdpace/	San Diego PACE (Medicare Only) (PACE)	08	20		1			H9616	002	0	2016	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																
H9689	001	0	1	01	01	H9689_001_0	5	2	1	08/03/2015	2016.01	08/03/2015 09:45:10 AM Central Daylight Time	08/03/2015 09:43:20 AM Central Daylight Time	08/02/2015 05:09:15 PM Central Daylight Time			08/04/2015 03:22:04 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Connect	healthalliancemedicare.org	Health Alliance Medicare (HMO SNP)	01	01		1			H9689	001	0	2016	Central IL		2	380	2			1	3		1	3		1	www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(877)642-3387		(877)642-3387		(800)965-4022		(800)965-4022		(877)642-3387		(877)642-3387		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					1					2	2			
H9699	004	1	1	01	01	H9699_004_1	7		1	08/03/2015	2016.01	08/03/2015 01:28:28 PM Central Daylight Time	08/04/2015 02:47:21 PM Central Daylight Time	08/04/2015 02:47:22 PM Central Daylight Time			08/04/2015 02:54:34 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkbluecross.com	Medi-Pak Advantage (HMO)	01	01		1			H9699	004	1	2016	Some Western and Central AR counties	Northwest and West Central AR counties	2	1681	2			2							http://www.arkansasbluecross.com/lookingforinsurance/medicareplans/2014/default.aspx	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9699	004	2	1	01	01	H9699_004_2	6		1	08/03/2015	2016.01	08/03/2015 01:28:47 PM Central Daylight Time	08/04/2015 02:47:23 PM Central Daylight Time	08/04/2015 02:47:10 PM Central Daylight Time			08/04/2015 02:54:34 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkbluecross.com	Medi-Pak Advantage (HMO)	01	01		1			H9699	004	2	2016	Some Western and Central AR counties	Cleburne, Jefferson, Lonoke, Pulaski counties	2	724	2			2							http://www.arkansasbluecross.com/lookingforinsurance/medicareplans/2014/default.aspx	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9712	001	0	1	48	05	H9712_001_0	7		1	08/27/2015	2016.01	08/27/2015 01:39:42 PM Eastern Daylight Time					08/27/2015 01:42:13 PM Eastern Daylight Time	HAP MIDWEST HEALTH PLAN, INC.	HAP Midwest MI Health Link	www.hap.org/midwest	HAP Midwest MI Health Link (Medicare-Medicaid Plan)	05	48		1			H9712	001	0	2016	HAP Midwest MI Health Link		2	12000	2			2							www.hap.org/midwest	www.hap.org/midwest	www.hap.org/midwest	(888)654-0706		(313)581-3700		(888)654-0706		(313)581-3700		(888)445-5580		(313)581-3700		(888)654-0706		(313)581-3700		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2				
H9725	001	0	1	01	01	H9725_001_0	4		1	07/14/2015	2016.01	07/14/2015 04:01:52 PM Central Daylight Time	08/01/2015 09:49:44 AM Central Daylight Time	07/30/2015 08:34:40 AM Central Daylight Time			08/03/2015 04:10:23 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H9725	001	0	2016	North Carolina		2		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	003	0	1	01	01	H9725_003_0	4	2	1	07/31/2015	2016.01	07/31/2015 08:52:11 AM Central Daylight Time	08/01/2015 09:50:15 AM Central Daylight Time	07/30/2015 08:35:13 AM Central Daylight Time			08/03/2015 04:10:23 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H9725	003	0	2016	North Carolina		2		2			1	3		1	2			www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	801	0	1	01	01	H9725_801_0	3		1	05/21/2015	2016.01	05/21/2015 09:05:49 PM Central Daylight Time	07/12/2015 10:04:49 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H9725	801	0	2016	North Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H9725	802	0	1	02	01	H9725_802_0	3		1	05/21/2015	2016.01	05/21/2015 09:06:01 PM Central Daylight Time	07/12/2015 10:05:20 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H9725	802	0	2016	North Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H9725	803	0	1	01	01	H9725_803_0	3		1	05/21/2015	2016.01	05/21/2015 09:06:12 PM Central Daylight Time	07/12/2015 10:05:50 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H9725	803	0	2016	North Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H9725	804	0	1	02	01	H9725_804_0	3		1	05/21/2015	2016.01	05/21/2015 09:06:24 PM Central Daylight Time	07/12/2015 10:06:20 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H9725	804	0	2016	North Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H9725	805	0	1	01	01	H9725_805_0	3		1	05/21/2015	2016.01	05/21/2015 09:06:35 PM Central Daylight Time	07/12/2015 10:06:50 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H9725	805	0	2016	North Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1					1	2			
H9725	806	0	1	02	01	H9725_806_0	3		1	05/21/2015	2016.01	05/21/2015 09:06:48 PM Central Daylight Time	07/12/2015 10:07:20 AM Central Daylight Time				07/16/2015 09:57:08 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.cignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H9725	806	0	2016	North Carolina		1		2			2							www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;12;15;16b;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a;9b;12;14d;14e;18a;	1	2			
H9730	002	0	1	02	01	H9730_002_0	5		1	08/01/2015	2016.01	08/01/2015 09:39:26 AM Eastern Daylight Time	08/03/2015 02:11:24 PM Eastern Daylight Time	08/03/2015 04:08:39 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	01	02		1			H9730	002	0	2016	Select Counties in KY		2	4296	2			2							www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)560-2766		(877)560-2766		(866)527-0056		(866)527-0056		(877)560-3206		(877)560-3206		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H9730	003	0	1	01	01	H9730_003_0	5	2	1	07/10/2015	2016.01	07/10/2015 01:25:09 PM Eastern Daylight Time	08/03/2015 02:12:13 PM Eastern Daylight Time	08/03/2015 04:09:08 PM Eastern Daylight Time			08/05/2015 11:03:45 AM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	WellCare	www.wellcare.com/medicare	Wellcare Access (HMO SNP)	01	01		1			H9730	003	0	2016	Select Counties in KY		2	3724	2			1	3		1	5			www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)560-3206		(877)560-3206		(866)527-0056		(866)527-0056		(877)560-2766		(877)560-2766		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2	2			
H9808	004	0	1	04	01	H9808_004_0	5		1	08/05/2015	2016.01	08/05/2015 06:58:02 PM Eastern Daylight Time	08/06/2015 10:06:09 AM Eastern Daylight Time	08/04/2015 02:48:44 PM Eastern Daylight Time			08/06/2015 10:11:10 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Care N' Care Insurance Company of North Carolina	www.cnchealthplannc.com	HealthTeam Advantage Plan I (PPO)	01	04		1			H9808	004	0	2016	Piedmont/Triad		2		2			2							www.cnchealthplannc.com	www.cnchealthplannc.com	www.cnchealthplannc.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	005	0	1	04	01	H9808_005_0	6		1	08/05/2015	2016.01	08/05/2015 05:15:41 PM Eastern Daylight Time	08/06/2015 10:08:58 AM Eastern Daylight Time	08/04/2015 02:52:22 PM Eastern Daylight Time			08/06/2015 10:11:10 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Care N' Care Insurance Company of North Carolina	www.cnchealthplannc.com	HealthTeam Advantage Plan II (PPO)	01	04		1			H9808	005	0	2016	Piedmont/Triad		2		2			2							www.cnchealthplannc.com	www.cnchealthplannc.com	www.cnchealthplannc.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	804	0	1	04	01	H9808_804_0	6		1	05/27/2015	2016.01	05/27/2015 12:25:45 PM Eastern Daylight Time	06/23/2015 03:47:56 PM Eastern Daylight Time				07/09/2015 05:16:28 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Care N' Care Insurance Company of North Carolina	www.cnchealthplannc.com	HealthTeam Advantage Employer Group NCY (PPO)	01	04		1			H9808	804	0	2016	Piedmont/Triad		1		2			2							www.cnchealthplannc.com	www.cnchealthplannc.com	www.cnchealthplannc.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
H9830	001	0	1	20	08	H9830_001_0	1		1	05/28/2015	2016.01	05/28/2015 11:23:12 AM Eastern Daylight Time		05/26/2015 09:16:53 AM Eastern Daylight Time			05/28/2015 11:30:36 AM Eastern Daylight Time	NEWCOURTLAND LIFE PROGRAM	NewCourtland LIFE Program	www.newcourtlandlife.org	NewCourtland LIFE  - Dual (PACE)	08	20		1			H9830	001	0	2016	NewCourtland LIFE - Dual		2		2			2								N/A	http://www.medicineshoppe.com/FranchiseeLocations/1024/SpecialServices.aspx									(888)625-4334		(267)335-1500		(888)625-4334		(267)335-1500										(888)625-4334		(267)335-1500		(888)625-4334		(267)335-1500																
H9830	002	0	1	20	08	H9830_002_0	1		1	05/28/2015	2016.01	05/28/2015 11:24:13 AM Eastern Daylight Time		05/26/2015 09:17:38 AM Eastern Daylight Time			05/28/2015 11:30:36 AM Eastern Daylight Time	NEWCOURTLAND LIFE PROGRAM	NewCourtland LIFE Program	www.newcourtlandlife.org	NewCourland LIFE - Medicare only (PACE)	08	20		1			H9830	002	0	2016	NewCourtland LIFE - Medicare only		2		2			2								N/A	http://www.medicineshoppe.com/FranchiseeLocations/1024/SpecialServices.aspx									(888)625-4334		(267)335-1500		(888)625-4334		(267)335-1500										(888)625-4334		(267)335-1500		(888)625-4334		(267)335-1500																
H9834	001	0	1	01	01	H9834_001_0	4		1	07/02/2015	2016.01	07/02/2015 10:34:21 PM Central Daylight Time	05/29/2015 01:56:25 PM Central Daylight Time	06/01/2015 12:53:41 PM Central Daylight Time			07/02/2015 10:50:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Gundersen Health Plan Minnesota	www.seniorpreferred.org	Gundersen MN Senior Preferred Elite (w/Rx) (HMO)	01	01		1			H9834	001	0	2016	Counties: Fillmore, Houston, Winona		2	6841	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	http://www.gundersenhealthplan.org/PartDFormulary	http://www.gundersenhealthplan.org/providerdirectory	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H9834	003	0	1	01	01	H9834_003_0	4		1	07/02/2015	2016.01	07/02/2015 10:35:37 PM Central Daylight Time	05/29/2015 01:57:18 PM Central Daylight Time	06/01/2015 12:54:09 PM Central Daylight Time			07/02/2015 10:50:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Gundersen Health Plan Minnesota	www.seniorpreferred.org	Gundersen MN Senior Preferred Value (w/Rx) (HMO)	01	01		1			H9834	003	0	2016	Counties: Fillmore, Houston, Winona		2	4858	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	http://www.gundersenhealthplan.org/PartDFormulary	http://www.gundersenhealthplan.org/providerdirectory	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(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	2		1	07/02/2015	2016.01	07/02/2015 10:36:30 PM Central Daylight Time	05/29/2015 01:55:22 PM Central Daylight Time				07/02/2015 10:50:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Gundersen Health Plan Minnesota	www.seniorpreferred.org	Gundersen MN Senior Preferred Value (no Rx) (HMO)	01	01		1			H9834	004	0	2016	Counties: Fillmore, Houston, Winona		2	1483	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	N/A	N/A	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H9834	005	0	1	01	01	H9834_005_0	2		1	07/02/2015	2016.01	07/02/2015 10:33:37 PM Central Daylight Time	05/29/2015 01:56:56 PM Central Daylight Time				07/02/2015 10:50:22 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Gundersen Health Plan Minnesota	www.seniorpreferred.org	Gundersen MN Senior Preferred Elite (no Rx) (HMO)	01	01		1			H9834	005	0	2016	Counties: Fillmore, Houston, Winona		2	2333	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	N/A	N/A	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H9859	001	0	1	02	01	H9859_001_0	8		1	07/24/2015	2016.01	07/24/2015 04:35:33 PM Eastern Daylight Time	07/15/2015 04:37:38 PM Eastern Daylight Time				07/24/2015 04:47:48 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Preferred Gold without Part D (HMO-POS)	01	02		1			H9859	001	0	2016	Eastern NY, S. Tier NY, Hudson Valley NY		2	370	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H9859	002	0	1	02	01	H9859_002_0	11		1	07/24/2015	2016.01	07/24/2015 04:35:46 PM Eastern Daylight Time	08/04/2015 07:22:45 AM Eastern Daylight Time	08/04/2015 07:22:53 AM Eastern Daylight Time			08/04/2015 08:52:49 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Preferred Gold with Part D (HMO-POS)	01	02		1			H9859	002	0	2016	Eastern NY, S. Tier NY, Hudson Valley NY		2	4087	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(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			
H9859	013	0	1	02	01	H9859_013_0	9		1	07/24/2015	2016.01	07/24/2015 04:35:57 PM Eastern Daylight Time	08/04/2015 07:23:01 AM Eastern Daylight Time	08/04/2015 07:23:08 AM Eastern Daylight Time			08/04/2015 08:52:49 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	GoldValue with Part D (HMO-POS)	01	02		1			H9859	013	0	2016	Cent. NY, Eastern NY, Hudson Valley NY, Western VT		2	2996	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(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			
H9859	802	0	1	02	01	H9859_802_0	4		1	05/27/2015	2016.01	05/27/2015 04:03:35 PM Eastern Daylight Time	06/01/2015 11:41:57 PM Eastern Daylight Time				06/02/2015 12:04:34 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	Preferred Gold Rx - Employer Group (HMO-POS)	01	02		1			H9859	802	0	2016	Employer Group East Region		1	4093	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	2		1	2			
H9870	001	0	1	01	01	H9870_001_0	6	2	1	07/07/2015	2016.01	07/07/2015 01:34:58 PM Eastern Daylight Time	06/01/2015 02:21:09 PM Eastern Daylight Time	06/01/2015 02:03:18 PM Eastern Daylight Time			07/07/2015 01:37:23 PM Eastern Daylight Time	UNIVERSITY HEALTH CARE, INC.	Passport Advantage	www.passportadvantage.com	Passport Advantage (HMO SNP)	01	01		1			H9870	001	0	2016	Jefferson, Hardin, Bullitt and Nelson Counties		2	2000	2			1	3		1	3		1	www.passportadvantage.com	www.passportadvantage.com	www.passportadvantage.com	(844)859-6152		(844)859-6152		(844)859-6152		(844)859-6152		(844)859-6152		(844)859-6152		(844)859-6152		(844)859-6152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9886	003	0	1	01	01	H9886_003_0	8	2	1	08/02/2015	2016.01	08/02/2015 10:05:59 AM Eastern Daylight Time	08/01/2015 09:54:47 PM Eastern Daylight Time	07/30/2015 07:35:34 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	HMO MISSOURI, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H9886	003	0	2016	Missouri		2	664	2			1	3		1	5			www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8826		(855)251-8826		(844)316-0358		(844)316-0358		(855)251-8826		(855)251-8826		(844)316-0358		(844)316-0358		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9886	004	0	1	01	01	H9886_004_0	8		1	08/01/2015	2016.01	08/01/2015 09:43:16 AM Eastern Daylight Time	08/01/2015 09:55:21 PM Eastern Daylight Time	07/30/2015 06:22:35 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	HMO MISSOURI, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9886	004	0	2016	Missouri Select Counties		2	4085	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8826		(855)251-8826		(844)373-7111		(844)373-7111		(855)251-8826		(855)251-8826		(844)373-7110		(844)373-7110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9886	801	0	1	01	01	H9886_801_0	3		1	05/20/2015	2016.01	05/20/2015 11:30:57 AM Pacific Daylight Time	05/31/2015 03:04:17 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	HMO MISSOURI, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H9886	801	0	2016	Select Counties in Missouri		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H9886	802	0	1	01	01	H9886_802_0	3		1	05/20/2015	2016.01	05/20/2015 11:31:00 AM Pacific Daylight Time	05/31/2015 03:04:21 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	HMO MISSOURI, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H9886	802	0	2016	Select Counties in Missouri		1	50	2			2							www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H9915	001	0	1	01	01	H9915_001_0	7		1	07/13/2015	2016.01	07/13/2015 01:30:29 PM Eastern Daylight Time	07/31/2015 09:12:02 AM Eastern Daylight Time	07/31/2015 09:15:12 AM Eastern Daylight Time			08/05/2015 05:59:06 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice (HMO)	01	01		1			H9915	001	0	2016	DC Metro		2		2			2							www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2	2			
H9915	006	0	1	01	01	H9915_006_0	6	2	1	08/04/2015	2016.01	08/04/2015 04:18:24 PM Eastern Daylight Time	07/31/2015 09:11:12 AM Eastern Daylight Time	07/31/2015 09:15:46 AM Eastern Daylight Time			08/05/2015 05:59:06 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice Dual Advantage (HMO SNP)	01	01		1			H9915	006	0	2016	DC Metro		2		2			1	3		1	3		2	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2	2			
H9915	007	0	1	01	01	H9915_007_0	7		1	07/13/2015	2016.01	07/13/2015 01:31:52 PM Eastern Daylight Time	07/31/2015 09:12:50 AM Eastern Daylight Time	07/31/2015 09:16:22 AM Eastern Daylight Time			08/05/2015 05:59:06 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice Care Advantage (HMO SNP)	01	01		1			H9915	007	0	2016	DC Metro		2		2			1	4		1		00000000000000000100		www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2	2			
H9915	008	0	1	01	01	H9915_008_0	8		1	07/13/2015	2016.01	07/13/2015 01:33:05 PM Eastern Daylight Time	07/31/2015 09:13:24 AM Eastern Daylight Time	07/31/2015 09:16:52 AM Eastern Daylight Time			08/05/2015 05:59:06 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice (HMO)	01	01		1			H9915	008	0	2016	Baltimore Metro, Baltimore and DC Suburbs		2		2			2							www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2	2			
H9915	009	0	1	01	01	H9915_009_0	4	2	1	08/04/2015	2016.01	08/04/2015 04:19:05 PM Eastern Daylight Time	07/31/2015 09:13:54 AM Eastern Daylight Time	07/31/2015 09:17:18 AM Eastern Daylight Time			08/05/2015 05:59:06 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice Dual Advantage (HMO SNP)	01	01		1			H9915	009	0	2016	Baltimore Metro, Baltimore and DC Suburbs		2		2			1	3		1	3		2	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2	2			
H9915	010	0	1	01	01	H9915_010_0	7		1	07/13/2015	2016.01	07/13/2015 01:34:19 PM Eastern Daylight Time	07/31/2015 09:14:46 AM Eastern Daylight Time	07/31/2015 09:17:44 AM Eastern Daylight Time			08/05/2015 05:59:06 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice Care Advantage (HMO SNP)	01	01		1			H9915	010	0	2016	Baltimore Metro, Baltimore and DC Suburbs		2		2			1	4		1		00000000000000000100		www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2	2			
H9947	005	1	1	04	01	H9947_005_1	10		1	07/20/2015	2016.01	07/20/2015 10:13:50 AM Eastern Daylight Time	08/01/2015 09:55:54 PM Eastern Daylight Time	07/30/2015 06:19:19 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	BCBSGa MediBlue Access (PPO)	01	04		1			H9947	005	1	2016	Georgia Metro Area	Segment 001	2	518	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)438-9968		(866)438-9968		(844)364-2131		(844)364-2131		(866)438-9968		(866)438-9968		(844)364-2125		(844)364-2125		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9947	005	2	1	04	01	H9947_005_2	10		1	07/20/2015	2016.01	07/20/2015 10:10:11 AM Eastern Daylight Time	08/01/2015 09:56:28 PM Eastern Daylight Time	07/30/2015 06:20:00 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	BCBSGa MediBlue Access (PPO)	01	04		1			H9947	005	2	2016	Georgia Metro Area	Segment 002	2	1309	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)438-9968		(866)438-9968		(844)364-2131		(844)364-2131		(866)438-9968		(866)438-9968		(844)364-2125		(844)364-2125		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9947	801	0	1	04	01	H9947_801_0	4		1	05/29/2015	2016.01	05/29/2015 12:41:10 PM Pacific Daylight Time	05/31/2015 09:39:19 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred (PPO)	01	04		1			H9947	801	0	2016	Georgia		1	453	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H9947	802	0	1	04	01	H9947_802_0	4		1	05/29/2015	2016.01	05/29/2015 12:41:19 PM Pacific Daylight Time	05/31/2015 09:39:24 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred (PPO)	01	04		1			H9947	802	0	2016	Georgia		1	50	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H9947	803	0	1	04	01	H9947_803_0	4		1	05/29/2015	2016.01	05/29/2015 12:41:31 PM Pacific Daylight Time	05/31/2015 01:18:25 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred (PPO)	01	04		1			H9947	803	0	2016	Georgia		1	50	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H9947	805	0	2	04	01	H9947_805_0	4		1	05/29/2015	2016.01	05/29/2015 12:40:30 PM Pacific Daylight Time	05/31/2015 09:39:30 AM Pacific Daylight Time				05/31/2015 08:05:48 PM Pacific Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred (PPO)	01	04		2	1		H9947	805	0	2016	Georgia		1	50	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1						2			
H9954	002	0	1	01	01	H9954_002_0	8		1	08/01/2015	2016.01	08/01/2015 09:44:46 AM Eastern Daylight Time	08/01/2015 09:57:01 PM Eastern Daylight Time	07/30/2015 06:27:08 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9954	002	0	2016	Ft. Wayne		2	516	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9954	004	0	1	01	01	H9954_004_0	9	2	1	08/01/2015	2016.01	08/01/2015 09:47:16 AM Eastern Daylight Time	08/01/2015 09:57:34 PM Eastern Daylight Time	07/30/2015 07:36:17 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO SNP)	01	01		1			H9954	004	0	2016	Indiana		2	750	2			1	3		1	5			www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8827		(855)251-8827		(844)316-0358		(844)316-0358		(855)251-8827		(855)251-8827		(844)316-0358		(844)316-0358		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9954	005	0	1	01	01	H9954_005_0	8		1	08/01/2015	2016.01	08/01/2015 09:45:37 AM Eastern Daylight Time	08/01/2015 09:58:04 PM Eastern Daylight Time	07/30/2015 06:23:12 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9954	005	0	2016	Indiana Select Counties		2	457	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9954	006	0	1	01	01	H9954_006_0	8		1	08/01/2015	2016.01	08/01/2015 09:46:04 AM Eastern Daylight Time	08/01/2015 09:58:37 PM Eastern Daylight Time	07/30/2015 06:32:47 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	01	01		1			H9954	006	0	2016	Central and Southern Indiana		2	2159	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9954	801	0	1	01	01	H9954_801_0	3		1	05/20/2015	2016.01	05/20/2015 11:31:00 AM Pacific Daylight Time	05/31/2015 03:04:25 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H9954	801	0	2016	Select Counties in Indiana		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H9954	802	0	1	01	01	H9954_802_0	3		1	05/20/2015	2016.01	05/20/2015 11:31:03 AM Pacific Daylight Time	05/31/2015 03:04:29 PM Pacific Daylight Time				05/31/2015 03:40:24 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H9954	802	0	2016	Select Counties in Indiana		1	50	2			2							www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;10a;11a;11b;11c;14d;14e;15;18a;	2		1					1	2			
H9998	001	0	1	20	08	H9998_001_0	2		1	05/21/2015	2016.01	05/21/2015 11:46:11 AM Central Daylight Time		05/20/2015 04:52:01 PM Central Daylight Time			05/21/2015 11:46:46 AM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstarlubbock.org	Silver Star - Dual (PACE)	08	20		1			H9998	001	0	2016	Silver Star - Dual		2		2			2								www.silverstarlubbock.org	http://www.seniorscript.com/									(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	05/21/2015	2016.01	05/21/2015 11:46:22 AM Central Daylight Time		05/20/2015 04:59:40 PM Central Daylight Time			05/21/2015 11:46:46 AM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstarlubbock.org	Silver Star - Medicare only (PACE)	08	20		1			H9998	002	0	2016	Silver Star - Medicare only		2		2			2								www.silverstarlubbock.org	http://www.seniorscript.com/									(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500										(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500																
R3175	003	0	1	31	11	R3175_003_0	4	2	1	08/03/2015	2016.01	08/03/2015 10:27:43 AM Central Daylight Time	07/31/2015 01:04:57 PM Central Daylight Time	07/30/2015 10:35:32 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO SNP)	11	31		1			R3175	003	0	2016	State of Hawaii		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3175	801	0	1	31	11	R3175_801_0	2		1	04/13/2015	2016.01	04/13/2015 02:24:53 PM Central Daylight Time	07/31/2015 01:05:23 PM Central Daylight Time				08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	801	0	2016	State of Hawaii		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
R3175	802	0	1	31	11	R3175_802_0	2		1	04/13/2015	2016.01	04/13/2015 02:27:08 PM Central Daylight Time	07/31/2015 01:05:48 PM Central Daylight Time				08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	802	0	2016	State of Hawaii		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
R3332	001	0	1	31	11	R3332_001_0	6		1	07/29/2015	2016.01	07/29/2015 08:08:12 AM Eastern Daylight Time	08/03/2015 12:58:50 PM Eastern Daylight Time	07/29/2015 04:29:59 PM Eastern Daylight Time			08/04/2015 04:27:35 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Regional PPO (Regional PPO)	11	31		1			R3332	001	0	2016	State of Florida		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2						2			
R3444	008	0	1	31	11	R3444_008_0	4		1	07/31/2015	2016.01	07/31/2015 12:59:03 PM Central Daylight Time	07/31/2015 01:02:45 PM Central Daylight Time	07/30/2015 10:26:04 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Silver Rx (Regional PPO SNP)	11	31		1			R3444	008	0	2016	Arkansas and Missouri		2		2			1	4		1		00000000000000000100		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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	2		1	07/31/2015	2016.01	07/31/2015 01:00:46 PM Central Daylight Time	07/31/2015 01:03:11 PM Central Daylight Time	07/30/2015 10:26:28 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (Regional PPO SNP)	11	31		1			R3444	009	0	2016	Arkansas and Missouri		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3444	011	0	1	31	11	R3444_011_0	4	2	1	07/31/2015	2016.01	07/31/2015 01:01:39 PM Central Daylight Time	07/31/2015 01:03:36 PM Central Daylight Time	07/30/2015 10:26:57 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Dual Advantage (Regional PPO SNP)	11	31		1			R3444	011	0	2016	Arkansas and Missouri		2		2			1	3		1	5			www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3444	012	0	1	31	11	R3444_012_0	2		1	07/31/2015	2016.01	07/31/2015 01:06:18 PM Central Daylight Time	07/31/2015 01:04:02 PM Central Daylight Time	07/30/2015 10:27:22 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (Regional PPO)	11	31		1			R3444	012	0	2016	Arkansas and Missouri		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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			
R5287	001	0	1	31	11	R5287_001_0	2		1	07/31/2015	2016.01	07/31/2015 02:35:38 PM Central Daylight Time	07/31/2015 03:08:44 PM Central Daylight Time	07/30/2015 10:27:46 AM Central Daylight Time			08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (Regional PPO)	11	31		1			R5287	001	0	2016	State of Florida		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			
R5287	002	0	1	31	11	R5287_002_0	2		1	07/31/2015	2016.01	07/31/2015 02:35:21 PM Central Daylight Time	07/31/2015 03:09:07 PM Central Daylight Time				08/03/2015 05:25:39 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Essential (Regional PPO)	11	31		1			R5287	002	0	2016	State of Florida		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			
R5287	003	0	1	31	11	R5287_003_0	3	2	1	07/31/2015	2016.01	07/31/2015 03:27:32 PM Central Daylight Time	08/03/2015 09:29:40 AM Central Daylight Time	07/30/2015 10:28:13 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO SNP)	11	31		1			R5287	003	0	2016	State of Florida		2		2			1	3		1	2			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			
R5342	001	0	1	31	11	R5342_001_0	2		1	07/31/2015	2016.01	07/31/2015 11:04:13 AM Central Daylight Time	07/31/2015 02:27:57 PM Central Daylight Time	07/30/2015 10:28:38 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)	11	31		1			R5342	001	0	2016	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	05/21/2015	2016.01	05/21/2015 11:10:17 AM Central Daylight Time	07/31/2015 02:28:20 PM Central Daylight Time				08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)	11	31		1			R5342	002	0	2016	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	07/31/2015	2016.01	07/31/2015 11:06:06 AM Central Daylight Time	07/31/2015 02:28:42 PM Central Daylight Time	07/30/2015 10:29:03 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)	11	31		1			R5342	005	0	2016	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	07/31/2015	2016.01	07/31/2015 11:08:10 AM Central Daylight Time	07/31/2015 02:29:05 PM Central Daylight Time	07/30/2015 10:29:27 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Plan 4 (Regional PPO)	11	31		1			R5342	006	0	2016	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	2		1	04/13/2015	2016.01	04/13/2015 02:29:14 PM Central Daylight Time	07/31/2015 02:29:28 PM Central Daylight Time				08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	801	0	2016	State of New York		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
R5342	802	0	1	31	11	R5342_802_0	2		1	04/13/2015	2016.01	04/13/2015 02:31:03 PM Central Daylight Time	07/31/2015 02:29:51 PM Central Daylight Time				08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	802	0	2016	State of New York		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1						2			
R5342	803	0	1	31	11	R5342_803_0	2		1	04/13/2015	2016.01	04/13/2015 02:34:25 PM Central Daylight Time	07/31/2015 02:30:15 PM Central Daylight Time				08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	803	0	2016	New York		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1						2			
R5826	001	0	1	31	11	R5826_001_0	4		1	07/08/2015	2016.01	07/08/2015 08:23:13 AM Eastern Daylight Time	08/01/2015 10:03:38 AM Eastern Daylight Time	07/30/2015 01:00:10 AM Eastern Daylight Time			08/04/2015 01:19:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-001 (Regional PPO)	11	31		1			R5826	001	0	2016	States of Alabama and Tennessee		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	002	0	1	31	11	R5826_002_0	4		1	07/08/2015	2016.01	07/08/2015 12:54:24 PM Eastern Daylight Time	07/31/2015 06:41:30 PM Eastern Daylight Time	07/30/2015 01:00:44 AM Eastern Daylight Time			08/04/2015 01:55:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-002 (Regional PPO)	11	31		1			R5826	002	0	2016	States of Pennsylvania and West Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	005	0	1	31	11	R5826_005_0	4		1	07/08/2015	2016.01	07/08/2015 07:36:51 AM Eastern Daylight Time	07/31/2015 05:40:23 PM Eastern Daylight Time	07/30/2015 01:01:20 AM Eastern Daylight Time			08/04/2015 02:11:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-005 (Regional PPO)	11	31		1			R5826	005	0	2016	State of Florida		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	006	0	1	31	11	R5826_006_0	4		1	07/08/2015	2016.01	07/08/2015 04:04:47 PM Eastern Daylight Time	08/04/2015 10:42:45 AM Eastern Daylight Time	07/30/2015 01:02:22 AM Eastern Daylight Time			08/04/2015 01:21:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-006 (Regional PPO)	11	31		1			R5826	006	0	2016	State of Michigan		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	007	0	1	31	11	R5826_007_0	5		1	07/31/2015	2016.01	07/31/2015 10:36:17 AM Eastern Daylight Time	07/31/2015 06:04:25 PM Eastern Daylight Time	07/30/2015 01:02:58 AM Eastern Daylight Time			08/04/2015 02:24:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-007 (Regional PPO)	11	31		1			R5826	007	0	2016	State of Ohio		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	008	0	1	31	11	R5826_008_0	4		1	07/31/2015	2016.01	07/31/2015 10:47:49 AM Eastern Daylight Time	07/31/2015 05:20:39 PM Eastern Daylight Time	07/30/2015 01:03:38 AM Eastern Daylight Time			08/04/2015 01:55:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-008 (Regional PPO)	11	31		1			R5826	008	0	2016	States of Indiana and Kentucky		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	009	0	1	31	11	R5826_009_0	6		1	07/08/2015	2016.01	07/08/2015 09:34:44 AM Eastern Daylight Time	08/04/2015 10:38:44 AM Eastern Daylight Time	07/30/2015 01:04:14 AM Eastern Daylight Time			08/04/2015 01:21:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-009 (Regional PPO)	11	31		1			R5826	009	0	2016	States of Illinois and Wisconsin		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	010	0	1	31	11	R5826_010_0	4		1	08/03/2015	2016.01	08/03/2015 09:50:29 AM Eastern Daylight Time	08/03/2015 10:46:15 AM Eastern Daylight Time	07/30/2015 01:05:02 AM Eastern Daylight Time			08/04/2015 01:00:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-010 (Regional PPO)	11	31		1			R5826	010	0	2016	States of Arkansas and Missouri		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	011	0	1	31	11	R5826_011_0	5		1	07/08/2015	2016.01	07/08/2015 03:55:05 PM Eastern Daylight Time	08/03/2015 01:47:48 PM Eastern Daylight Time	07/30/2015 01:05:38 AM Eastern Daylight Time			08/04/2015 12:49:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-011 (Regional PPO)	11	31		1			R5826	011	0	2016	States of Louisiana and Mississippi		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	012	0	1	31	11	R5826_012_0	4		1	07/08/2015	2016.01	07/08/2015 08:25:03 AM Eastern Daylight Time	07/31/2015 04:43:31 PM Eastern Daylight Time	07/30/2015 01:06:18 AM Eastern Daylight Time			08/04/2015 03:22:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-012 (Regional PPO)	11	31		1			R5826	012	0	2016	State of Texas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	013	0	1	31	11	R5826_013_0	4		1	07/09/2015	2016.01	07/09/2015 03:37:09 PM Eastern Daylight Time	08/03/2015 10:44:11 AM Eastern Daylight Time	07/30/2015 01:06:54 AM Eastern Daylight Time			08/04/2015 01:00:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-013 (Regional PPO)	11	31		1			R5826	013	0	2016	States of Kansas and Oklahoma		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	014	0	1	31	11	R5826_014_0	4		1	07/07/2015	2016.01	07/07/2015 03:50:31 PM Eastern Daylight Time	07/31/2015 04:01:01 PM Eastern Daylight Time	07/30/2015 01:07:42 AM Eastern Daylight Time			08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-014 (Regional PPO)	11	31		1			R5826	014	0	2016	State of Arizona		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	018	0	1	31	11	R5826_018_0	4		1	07/31/2015	2016.01	07/31/2015 03:33:33 PM Eastern Daylight Time	07/31/2015 07:27:15 PM Eastern Daylight Time				08/04/2015 02:11:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-018 (Regional PPO)	11	31		1			R5826	018	0	2016	State of Florida		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	021	0	1	31	11	R5826_021_0	4		1	07/31/2015	2016.01	07/31/2015 10:41:01 AM Eastern Daylight Time	07/31/2015 05:40:43 PM Eastern Daylight Time				08/04/2015 02:24:43 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-021 (Regional PPO)	11	31		1			R5826	021	0	2016	State of Ohio		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	023	0	1	31	11	R5826_023_0	4		1	07/08/2015	2016.01	07/08/2015 09:39:18 AM Eastern Daylight Time	08/04/2015 10:45:56 AM Eastern Daylight Time				08/04/2015 01:21:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-023 (Regional PPO)	11	31		1			R5826	023	0	2016	States of Illinois and Wisconsin		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	026	0	1	31	11	R5826_026_0	4		1	07/31/2015	2016.01	07/31/2015 01:58:35 PM Eastern Daylight Time	07/31/2015 04:46:09 PM Eastern Daylight Time				08/04/2015 03:22:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-026 (Regional PPO)	11	31		1			R5826	026	0	2016	State of Texas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	053	0	1	31	11	R5826_053_0	4		1	07/08/2015	2016.01	07/08/2015 04:09:48 PM Eastern Daylight Time	08/04/2015 10:54:43 AM Eastern Daylight Time				08/04/2015 01:21:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-053 (Regional PPO)	11	31		1			R5826	053	0	2016	State of Michigan		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	062	0	1	31	11	R5826_062_0	4		1	07/20/2015	2016.01	07/20/2015 01:09:11 PM Eastern Daylight Time	07/31/2015 06:43:36 PM Eastern Daylight Time				08/04/2015 01:55:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-062 (Regional PPO)	11	31		1			R5826	062	0	2016	States of Pennsylvania and West Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	063	0	1	31	11	R5826_063_0	6		1	07/08/2015	2016.01	07/08/2015 08:23:20 AM Eastern Daylight Time	07/31/2015 04:26:58 PM Eastern Daylight Time				08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-063 (Regional PPO)	11	31		1			R5826	063	0	2016	States of North Carolina and Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	064	0	1	31	11	R5826_064_0	5		1	07/31/2015	2016.01	07/31/2015 12:54:06 PM Eastern Daylight Time	07/31/2015 10:58:24 AM Eastern Daylight Time				08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-064 (Regional PPO)	11	31		1			R5826	064	0	2016	States of Georgia and South Carolina		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	065	0	1	31	11	R5826_065_0	4		1	07/08/2015	2016.01	07/08/2015 08:23:58 AM Eastern Daylight Time	08/01/2015 09:55:11 AM Eastern Daylight Time				08/04/2015 01:19:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-065 (Regional PPO)	11	31		1			R5826	065	0	2016	States of Alabama and Tennessee		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	066	0	1	31	11	R5826_066_0	5		1	07/31/2015	2016.01	07/31/2015 10:50:16 AM Eastern Daylight Time	07/31/2015 05:13:35 PM Eastern Daylight Time				08/04/2015 01:55:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-066 (Regional PPO)	11	31		1			R5826	066	0	2016	States of Indiana and Kentucky		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	067	0	1	31	11	R5826_067_0	4		1	07/31/2015	2016.01	07/31/2015 12:49:00 PM Eastern Daylight Time	08/03/2015 10:47:14 AM Eastern Daylight Time				08/04/2015 01:00:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-067 (Regional PPO)	11	31		1			R5826	067	0	2016	States of Arkansas and Missouri		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	068	0	1	31	11	R5826_068_0	4		1	07/08/2015	2016.01	07/08/2015 08:29:44 AM Eastern Daylight Time	08/03/2015 01:56:14 PM Eastern Daylight Time				08/04/2015 12:49:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-068 (Regional PPO)	11	31		1			R5826	068	0	2016	States of Louisiana and Mississippi		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	069	0	1	31	11	R5826_069_0	4		1	07/16/2015	2016.01	07/16/2015 03:52:56 PM Eastern Daylight Time	08/03/2015 10:48:39 AM Eastern Daylight Time				08/04/2015 01:00:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-069 (Regional PPO)	11	31		1			R5826	069	0	2016	States of Kansas and Oklahoma		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	070	0	1	31	11	R5826_070_0	4		1	07/07/2015	2016.01	07/07/2015 03:50:48 PM Eastern Daylight Time	07/31/2015 03:59:04 PM Eastern Daylight Time				08/04/2015 01:09:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-070 (Regional PPO)	11	31		1			R5826	070	0	2016	State of Arizona		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(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	4		1	07/31/2015	2016.01	07/31/2015 02:38:23 PM Eastern Daylight Time	07/31/2015 07:28:29 PM Eastern Daylight Time	07/30/2015 01:08:18 AM Eastern Daylight Time			08/04/2015 02:11:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-074 (Regional PPO)	11	31		1			R5826	074	0	2016	State of Florida		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	077	0	1	31	11	R5826_077_0	5		1	07/31/2015	2016.01	07/31/2015 01:27:55 PM Eastern Daylight Time	07/31/2015 10:58:50 AM Eastern Daylight Time	07/30/2015 01:08:54 AM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-077 (Regional PPO)	11	31		1			R5826	077	0	2016	States of Georgia and South Carolina		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	078	0	1	31	11	R5826_078_0	5		1	07/08/2015	2016.01	07/08/2015 03:55:47 PM Eastern Daylight Time	08/03/2015 01:59:10 PM Eastern Daylight Time	07/30/2015 01:09:32 AM Eastern Daylight Time			08/04/2015 12:49:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-078 (Regional PPO)	11	31		1			R5826	078	0	2016	States of Louisiana and Mississippi		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	079	0	1	31	11	R5826_079_0	5		1	07/08/2015	2016.01	07/08/2015 04:40:19 PM Eastern Daylight Time	07/31/2015 04:27:28 PM Eastern Daylight Time	07/30/2015 01:10:08 AM Eastern Daylight Time			08/04/2015 01:02:20 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-079 (Regional PPO)	11	31		1			R5826	079	0	2016	States of North Carolina and Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	091	0	1	31	11	R5826_091_0	4		1	08/03/2015	2016.01	08/03/2015 01:04:31 PM Eastern Daylight Time	07/31/2015 05:06:16 PM Eastern Daylight Time	07/30/2015 01:10:44 AM Eastern Daylight Time			08/04/2015 03:22:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-091 (Regional PPO)	11	31		1			R5826	091	0	2016	State of Texas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	801	0	1	31	11	R5826_801_0	2		1	05/18/2015	2016.01	05/18/2015 02:38:45 PM Eastern Daylight Time	08/03/2015 12:01:35 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	801	0	2016	States of Alabama and Tennessee		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	802	0	1	31	11	R5826_802_0	3		1	05/18/2015	2016.01	05/18/2015 02:40:33 PM Eastern Daylight Time	08/03/2015 12:01:56 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	802	0	2016	States of Pennsylvania and West Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	803	0	1	31	11	R5826_803_0	2		1	05/18/2015	2016.01	05/18/2015 03:02:25 PM Eastern Daylight Time	08/03/2015 12:02:17 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	803	0	2016	States of North Carolina and Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	804	0	1	31	11	R5826_804_0	2		1	05/18/2015	2016.01	05/18/2015 03:02:33 PM Eastern Daylight Time	08/03/2015 12:02:38 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	804	0	2016	States of Georgia and South Carolina		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	805	0	1	31	11	R5826_805_0	2		1	05/18/2015	2016.01	05/18/2015 03:02:42 PM Eastern Daylight Time	08/03/2015 12:02:58 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	805	0	2016	State of Florida		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	806	0	1	31	11	R5826_806_0	2		1	05/18/2015	2016.01	05/18/2015 03:02:50 PM Eastern Daylight Time	08/03/2015 12:03:19 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	806	0	2016	State of Michigan		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	807	0	1	31	11	R5826_807_0	2		1	05/18/2015	2016.01	05/18/2015 03:02:58 PM Eastern Daylight Time	08/03/2015 12:03:40 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	807	0	2016	State of Ohio		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	808	0	1	31	11	R5826_808_0	2		1	05/18/2015	2016.01	05/18/2015 03:03:07 PM Eastern Daylight Time	08/03/2015 12:04:00 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	808	0	2016	States of Indiana and Kentucky		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	809	0	1	31	11	R5826_809_0	2		1	05/18/2015	2016.01	05/18/2015 03:03:15 PM Eastern Daylight Time	08/03/2015 12:05:02 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	809	0	2016	States of Illinois and Wisconsin		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	810	0	1	31	11	R5826_810_0	2		1	05/18/2015	2016.01	05/18/2015 03:03:24 PM Eastern Daylight Time	08/03/2015 12:04:21 PM Eastern Daylight Time				08/04/2015 09:21:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	810	0	2016	States of Arkansas and Missouri		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	811	0	1	31	11	R5826_811_0	2		1	05/18/2015	2016.01	05/18/2015 03:03:33 PM Eastern Daylight Time	08/03/2015 12:04:42 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	811	0	2016	States of Louisiana and Mississippi		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	812	0	1	31	11	R5826_812_0	2		1	05/18/2015	2016.01	05/18/2015 03:03:41 PM Eastern Daylight Time	08/03/2015 12:05:24 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	812	0	2016	State of Texas		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	813	0	1	31	11	R5826_813_0	2		1	05/18/2015	2016.01	05/18/2015 03:03:50 PM Eastern Daylight Time	08/03/2015 12:05:44 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	813	0	2016	States of Kansas and Oklahoma		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	814	0	1	31	11	R5826_814_0	2		1	05/18/2015	2016.01	05/18/2015 04:02:39 PM Eastern Daylight Time	08/03/2015 12:06:05 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	814	0	2016	State of Arizona		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	815	0	1	31	11	R5826_815_0	2		1	05/19/2015	2016.01	05/19/2015 10:10:32 AM Eastern Daylight Time	08/03/2015 12:06:25 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	815	0	2016	States of Alabama and Tennessee		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	816	0	1	31	11	R5826_816_0	2		1	05/19/2015	2016.01	05/19/2015 10:11:21 AM Eastern Daylight Time	08/03/2015 12:07:07 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	816	0	2016	States of Pennsylvania and West Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	817	0	1	31	11	R5826_817_0	2		1	05/19/2015	2016.01	05/19/2015 10:11:46 AM Eastern Daylight Time	08/03/2015 12:07:48 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	817	0	2016	States of North Carolina and Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	818	0	1	31	11	R5826_818_0	2		1	05/19/2015	2016.01	05/19/2015 10:12:20 AM Eastern Daylight Time	08/03/2015 12:08:29 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	818	0	2016	States of Georgia and South Carolina		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	819	0	1	31	11	R5826_819_0	2		1	05/19/2015	2016.01	05/19/2015 10:15:04 AM Eastern Daylight Time	08/03/2015 12:09:10 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	819	0	2016	State of Florida		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	820	0	1	31	11	R5826_820_0	2		1	05/19/2015	2016.01	05/19/2015 10:16:04 AM Eastern Daylight Time	08/03/2015 12:09:52 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	820	0	2016	State of Michigan		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	821	0	1	31	11	R5826_821_0	2		1	05/19/2015	2016.01	05/19/2015 10:16:19 AM Eastern Daylight Time	08/03/2015 12:10:35 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	821	0	2016	State of Ohio		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	822	0	1	31	11	R5826_822_0	2		1	05/19/2015	2016.01	05/19/2015 10:16:44 AM Eastern Daylight Time	08/03/2015 12:11:18 PM Eastern Daylight Time				08/04/2015 09:27:05 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	822	0	2016	States of Indiana and Kentucky		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	823	0	1	31	11	R5826_823_0	2		1	05/19/2015	2016.01	05/19/2015 10:17:02 AM Eastern Daylight Time	08/03/2015 12:12:01 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	823	0	2016	States of Illinois and Wisconsin		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	824	0	1	31	11	R5826_824_0	2		1	05/19/2015	2016.01	05/19/2015 10:17:30 AM Eastern Daylight Time	08/03/2015 12:12:43 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	824	0	2016	States of Arkansas and Missouri		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	825	0	1	31	11	R5826_825_0	2		1	05/19/2015	2016.01	05/19/2015 10:17:44 AM Eastern Daylight Time	08/03/2015 12:13:26 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	825	0	2016	States of Louisiana and Mississippi		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	826	0	1	31	11	R5826_826_0	2		1	05/19/2015	2016.01	05/19/2015 10:18:05 AM Eastern Daylight Time	08/03/2015 12:14:08 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	826	0	2016	State of Texas		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	827	0	1	31	11	R5826_827_0	2		1	05/19/2015	2016.01	05/19/2015 10:18:19 AM Eastern Daylight Time	08/03/2015 12:14:50 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	827	0	2016	States of Kansas and Oklahoma		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	828	0	1	31	11	R5826_828_0	2		1	05/19/2015	2016.01	05/19/2015 10:18:33 AM Eastern Daylight Time	08/03/2015 12:15:33 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	828	0	2016	State of Arizona		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	831	0	1	31	11	R5826_831_0	2		1	05/18/2015	2016.01	05/18/2015 03:17:49 PM Eastern Daylight Time	08/03/2015 12:07:27 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	831	0	2016	States of Pennsylvania and West Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	832	0	1	31	11	R5826_832_0	2		1	05/18/2015	2016.01	05/18/2015 03:17:57 PM Eastern Daylight Time	08/03/2015 12:08:09 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	832	0	2016	States of North Carolina and Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	833	0	1	31	11	R5826_833_0	3		1	05/18/2015	2016.01	05/18/2015 03:18:05 PM Eastern Daylight Time	08/03/2015 12:08:50 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	833	0	2016	States of Georgia and South Carolina		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	834	0	1	31	11	R5826_834_0	3		1	05/18/2015	2016.01	05/18/2015 03:18:13 PM Eastern Daylight Time	08/03/2015 12:09:31 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	834	0	2016	State of Florida		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	835	0	1	31	11	R5826_835_0	3		1	05/18/2015	2016.01	05/18/2015 03:18:22 PM Eastern Daylight Time	08/03/2015 12:06:46 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	835	0	2016	States of Alabama and Tennessee		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	836	0	1	31	11	R5826_836_0	3		1	05/18/2015	2016.01	05/18/2015 03:18:30 PM Eastern Daylight Time	08/03/2015 12:10:14 PM Eastern Daylight Time				08/04/2015 09:30:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	836	0	2016	State of Michigan		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	837	0	1	31	11	R5826_837_0	3		1	05/18/2015	2016.01	05/18/2015 03:18:38 PM Eastern Daylight Time	08/03/2015 12:10:57 PM Eastern Daylight Time				08/04/2015 09:32:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	837	0	2016	State of Ohio		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	838	0	1	31	11	R5826_838_0	3		1	05/18/2015	2016.01	05/18/2015 03:18:46 PM Eastern Daylight Time	08/03/2015 12:11:39 PM Eastern Daylight Time				08/04/2015 09:32:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	838	0	2016	States of Indiana and Kentucky		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	839	0	1	31	11	R5826_839_0	3		1	05/18/2015	2016.01	05/18/2015 03:18:54 PM Eastern Daylight Time	08/03/2015 12:12:22 PM Eastern Daylight Time				08/04/2015 09:32:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	839	0	2016	States of Illinois and Wisconsin		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	840	0	1	31	11	R5826_840_0	3		1	05/18/2015	2016.01	05/18/2015 03:19:03 PM Eastern Daylight Time	08/03/2015 12:13:04 PM Eastern Daylight Time				08/04/2015 09:32:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	840	0	2016	States of Arkansas and Missouri		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	841	0	1	31	11	R5826_841_0	3		1	05/18/2015	2016.01	05/18/2015 03:19:11 PM Eastern Daylight Time	08/03/2015 12:13:47 PM Eastern Daylight Time				08/04/2015 09:32:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	841	0	2016	States of Louisiana and Mississippi		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	842	0	1	31	11	R5826_842_0	3		1	05/18/2015	2016.01	05/18/2015 03:19:20 PM Eastern Daylight Time	08/03/2015 12:14:29 PM Eastern Daylight Time				08/04/2015 09:32:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	842	0	2016	State of Texas		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	843	0	1	31	11	R5826_843_0	3		1	05/18/2015	2016.01	05/18/2015 03:19:28 PM Eastern Daylight Time	08/03/2015 12:15:12 PM Eastern Daylight Time				08/04/2015 09:32:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	843	0	2016	States of Kansas and Oklahoma		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5826	844	0	1	31	11	R5826_844_0	3		1	05/18/2015	2016.01	05/18/2015 03:19:36 PM Eastern Daylight Time	08/03/2015 12:15:54 PM Eastern Daylight Time				08/04/2015 09:32:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	844	0	2016	State of Arizona		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e;15;16b;18a;	1	1a;1b;2;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a;9b;9c;9d;12;14a;14d;14e;16b;18a;	1						2			
R5941	013	0	1	31	11	R5941_013_0	11		1	07/20/2015	2016.01	07/20/2015 10:15:37 AM Eastern Daylight Time	08/04/2015 08:12:14 PM Eastern Daylight Time				08/05/2015 07:12:42 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access Core (Regional PPO)	11	31		1			R5941	013	0	2016	Ohio		2	2684	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5941	014	0	1	31	11	R5941_014_0	11		1	07/20/2015	2016.01	07/20/2015 10:16:28 AM Eastern Daylight Time	08/03/2015 08:46:22 AM Eastern Daylight Time	07/30/2015 06:11:51 PM Eastern Daylight Time			08/05/2015 07:12:42 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (Regional PPO)	11	31		1			R5941	014	0	2016	Ohio		2	39552	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560		(800)467-1199		(800)467-1199		(844)364-2126		(844)364-2126		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5941	015	0	1	31	11	R5941_015_0	8		1	07/16/2015	2016.01	07/16/2015 04:23:03 PM Eastern Daylight Time	08/03/2015 08:47:25 AM Eastern Daylight Time	07/30/2015 06:12:30 PM Eastern Daylight Time			08/05/2015 07:12:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (Regional PPO)	11	31		1			R5941	015	0	2016	Indiana and Kentucky		2	60719	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560		(800)467-1199		(800)467-1199		(844)364-2126		(844)364-2126		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	001	0	1	31	11	R6694_001_0	8		1	08/02/2015	2016.01	08/02/2015 06:46:23 PM Eastern Daylight Time	08/01/2015 07:04:40 AM Eastern Daylight Time	07/29/2015 05:59:40 PM Eastern Daylight Time			08/03/2015 07:05:43 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare NJ Connect Gold (Regional PPO)	11	31		1			R6694	001	0	2016	New Jersey		2		2			2							www.aetnamedicaredocfind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	003	0	1	31	11	R6694_003_0	9		1	08/02/2015	2016.01	08/02/2015 06:46:29 PM Eastern Daylight Time	07/31/2015 12:04:49 PM Eastern Daylight Time	07/29/2015 05:59:59 PM Eastern Daylight Time			08/03/2015 07:05:43 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare OH Connect Gold (Regional PPO)	11	31		1			R6694	003	0	2016	Ohio		2		2			2							www.aetnamedicaredocfind.com	http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(800)282-5366		(800)282-5366		(855)338-7027		(855)338-7027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	008	0	1	31	11	R6801_008_0	4		1	07/31/2015	2016.01	07/31/2015 01:07:15 PM Central Daylight Time	07/31/2015 03:06:12 PM Central Daylight Time	07/30/2015 10:29:53 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Silver Rx (Regional PPO SNP)	11	31		1			R6801	008	0	2016	Texas		2		2			1	4		1		00000000000000000100		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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	2		1	07/31/2015	2016.01	07/31/2015 01:14:33 PM Central Daylight Time	07/31/2015 03:06:36 PM Central Daylight Time	07/30/2015 10:30:18 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (Regional PPO SNP)	11	31		1			R6801	009	0	2016	Texas		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	011	0	1	31	11	R6801_011_0	4	2	1	07/31/2015	2016.01	07/31/2015 01:17:37 PM Central Daylight Time	07/31/2015 03:07:06 PM Central Daylight Time	07/30/2015 10:30:46 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Dual Advantage (Regional PPO SNP)	11	31		1			R6801	011	0	2016	Texas		2		2			1	3		1	5			www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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	012	0	1	31	11	R6801_012_0	2		1	05/29/2015	2016.01	05/29/2015 10:55:51 AM Central Daylight Time	07/31/2015 03:07:31 PM Central Daylight Time	07/30/2015 10:31:11 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (Regional PPO)	11	31		1			R6801	012	0	2016	Texas		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7444	001	0	1	31	11	R7444_001_0	2		1	05/29/2015	2016.01	05/29/2015 09:57:23 AM Central Daylight Time	07/31/2015 01:22:37 PM Central Daylight Time	07/30/2015 10:31:37 AM Central Daylight Time			08/03/2015 03:52:53 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (Regional PPO)	11	31		1			R7444	001	0	2016	New England		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			
R9896	008	0	1	31	11	R9896_008_0	4		1	07/31/2015	2016.01	07/31/2015 01:18:35 PM Central Daylight Time	07/31/2015 02:34:39 PM Central Daylight Time	07/30/2015 10:32:05 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Silver Rx (Regional PPO SNP)	11	31		1			R9896	008	0	2016	Georgia and South Carolina		2		2			1	4		1		00000000000000000100		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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			
R9896	009	0	1	31	11	R9896_009_0	2		1	05/29/2015	2016.01	05/29/2015 10:56:11 AM Central Daylight Time	07/31/2015 02:35:14 PM Central Daylight Time	07/30/2015 10:32:38 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (Regional PPO SNP)	11	31		1			R9896	009	0	2016	Georgia and South Carolina		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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			
R9896	012	0	1	31	11	R9896_012_0	3		1	08/04/2015	2016.01	08/04/2015 02:53:24 PM Central Daylight Time	07/31/2015 02:35:50 PM Central Daylight Time	07/30/2015 10:33:12 AM Central Daylight Time			08/04/2015 02:55:39 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (Regional PPO)	11	31		1			R9896	012	0	2016	Georgia and South Carolina		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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			
R9896	021	0	1	31	11	R9896_021_0	4	2	1	07/31/2015	2016.01	07/31/2015 01:24:07 PM Central Daylight Time	07/31/2015 02:36:25 PM Central Daylight Time	07/30/2015 10:33:40 AM Central Daylight Time			08/03/2015 04:04:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Dual Advantage (Regional PPO SNP)	11	31		1			R9896	021	0	2016	Georgia and South Carolina		2		2			1	3		1	5			www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.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			
S0522	001	0		29	10	S0522_001_0	4		1	06/04/2015	2016.01	06/04/2015 04:07:22 PM Central Daylight Time		05/31/2015 02:34:34 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	001	0	2016	IL		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	002	0		29	10	S0522_002_0	8		1	07/17/2015	2016.01	07/17/2015 11:19:58 AM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	002	0	2016	NH ME		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	004	0		29	10	S0522_004_0	4		1	05/28/2015	2016.01	05/28/2015 01:50:32 PM Central Daylight Time		05/31/2015 02:35:58 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	004	0	2016	NJ		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	006	0		29	10	S0522_006_0	4		1	05/28/2015	2016.01	05/28/2015 01:53:24 PM Central Daylight Time		05/31/2015 02:36:16 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	006	0	2016	DE DC MD		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	008	0		29	10	S0522_008_0	4		1	05/28/2015	2016.01	05/28/2015 01:55:36 PM Central Daylight Time		05/31/2015 02:36:38 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	008	0	2016	VA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	010	0		29	10	S0522_010_0	4		1	05/28/2015	2016.01	05/28/2015 02:32:58 PM Central Daylight Time		05/31/2015 02:37:02 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	010	0	2016	NC		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	012	0		29	10	S0522_012_0	7		1	07/15/2015	2016.01	07/15/2015 03:18:58 PM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	012	0	2016	SC		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	014	0		29	10	S0522_014_0	4		1	05/29/2015	2016.01	05/29/2015 09:53:27 AM Central Daylight Time		05/31/2015 02:17:32 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	014	0	2016	GA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	016	0		29	10	S0522_016_0	4		1	05/28/2015	2016.01	05/28/2015 02:01:28 PM Central Daylight Time		05/31/2015 02:18:10 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	016	0	2016	AL TN		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	018	0		29	10	S0522_018_0	4		1	05/28/2015	2016.01	05/28/2015 02:03:28 PM Central Daylight Time		05/31/2015 02:38:10 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	018	0	2016	MI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	020	0		29	10	S0522_020_0	7		1	07/17/2015	2016.01	07/17/2015 10:46:55 AM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	020	0	2016	OH		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	022	0		29	10	S0522_022_0	7		1	07/17/2015	2016.01	07/17/2015 10:49:00 AM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	022	0	2016	IN KY		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	024	0		29	10	S0522_024_0	7		1	07/17/2015	2016.01	07/17/2015 10:51:48 AM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	024	0	2016	MS		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	026	0		29	10	S0522_026_0	7		1	07/17/2015	2016.01	07/17/2015 10:55:22 AM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	026	0	2016	LA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	028	0		29	10	S0522_028_0	4		1	05/28/2015	2016.01	05/28/2015 02:05:48 PM Central Daylight Time		05/31/2015 02:18:42 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	028	0	2016	CO		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	030	0		29	10	S0522_030_0	7		1	07/15/2015	2016.01	07/15/2015 01:49:59 PM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	030	0	2016	OR WA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	032	0		29	10	S0522_032_0	4		1	05/28/2015	2016.01	05/28/2015 02:07:45 PM Central Daylight Time		05/31/2015 02:19:12 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	032	0	2016	ID UT		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	034	0		29	10	S0522_034_0	7		1	07/17/2015	2016.01	07/17/2015 10:57:31 AM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	034	0	2016	CA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	036	0		29	10	S0522_036_0	4		1	05/28/2015	2016.01	05/28/2015 02:09:37 PM Central Daylight Time		05/31/2015 02:39:52 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	036	0	2016	WI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	037	0		29	10	S0522_037_0	4		1	05/28/2015	2016.01	05/28/2015 02:11:59 PM Central Daylight Time		05/31/2015 02:20:10 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	037	0	2016	MO		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	038	0		29	10	S0522_038_0	4		1	05/28/2015	2016.01	05/28/2015 02:14:00 PM Central Daylight Time		05/31/2015 02:21:16 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	038	0	2016	AR		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	039	0		29	10	S0522_039_0	4		1	05/28/2015	2016.01	05/28/2015 02:15:50 PM Central Daylight Time		05/31/2015 02:21:40 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	039	0	2016	TX		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	040	0		29	10	S0522_040_0	4		1	05/28/2015	2016.01	05/28/2015 03:22:41 PM Central Daylight Time		05/31/2015 02:38:50 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	040	0	2016	OK		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	041	0		29	10	S0522_041_0	7		1	07/17/2015	2016.01	07/17/2015 10:59:29 AM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	041	0	2016	KS		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	042	0		29	10	S0522_042_0	7		1	07/17/2015	2016.01	07/17/2015 11:07:13 AM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	042	0	2016	IA MN MT NE ND SD WY		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	043	0		29	10	S0522_043_0	4		1	05/28/2015	2016.01	05/28/2015 02:17:52 PM Central Daylight Time		05/31/2015 11:45:04 AM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	043	0	2016	NM		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	044	0		29	10	S0522_044_0	7		1	07/17/2015	2016.01	07/17/2015 11:05:03 AM Central Daylight Time		07/21/2015 12:46:13 PM Central Daylight Time			07/21/2015 02:46:17 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	044	0	2016	AZ		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	045	0		29	10	S0522_045_0	4		1	05/28/2015	2016.01	05/28/2015 02:19:24 PM Central Daylight Time		05/31/2015 02:22:06 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	045	0	2016	NV		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	046	0		29	10	S0522_046_0	4		1	05/29/2015	2016.01	05/29/2015 09:56:00 AM Central Daylight Time		05/31/2015 11:46:24 AM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	046	0	2016	HI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	047	0		29	10	S0522_047_0	4		1	05/28/2015	2016.01	05/28/2015 02:22:55 PM Central Daylight Time		05/31/2015 02:22:32 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	047	0	2016	AK		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	048	0		29	10	S0522_048_0	5		1	06/01/2015	2016.01	06/01/2015 02:16:01 PM Central Daylight Time		06/01/2015 01:14:10 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	048	0	2016	IL		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	049	0		29	10	S0522_049_0	5		1	05/29/2015	2016.01	05/29/2015 10:17:36 AM Central Daylight Time		06/01/2015 01:15:02 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	049	0	2016	Northern New England		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	050	0		29	10	S0522_050_0	5		1	05/29/2015	2016.01	05/29/2015 10:18:16 AM Central Daylight Time		06/01/2015 01:15:48 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	050	0	2016	New Jersey		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	051	0		29	10	S0522_051_0	5		1	05/29/2015	2016.01	05/29/2015 10:18:32 AM Central Daylight Time		06/01/2015 01:43:22 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	051	0	2016	Mid-Atlantic		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	052	0		29	10	S0522_052_0	5		1	05/29/2015	2016.01	05/29/2015 10:18:50 AM Central Daylight Time		06/01/2015 01:44:34 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	052	0	2016	Virginia		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	053	0		29	10	S0522_053_0	5		1	05/29/2015	2016.01	05/29/2015 10:19:07 AM Central Daylight Time		06/01/2015 01:17:54 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	053	0	2016	North Carolina		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	054	0		29	10	S0522_054_0	5		1	05/29/2015	2016.01	05/29/2015 10:19:22 AM Central Daylight Time		06/01/2015 01:18:42 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	054	0	2016	South Carolina		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	055	0		29	10	S0522_055_0	5		1	05/29/2015	2016.01	05/29/2015 10:19:37 AM Central Daylight Time		06/01/2015 01:19:44 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	055	0	2016	Georgia		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	056	0		29	10	S0522_056_0	5		1	05/29/2015	2016.01	05/29/2015 10:19:51 AM Central Daylight Time		06/01/2015 01:20:42 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	056	0	2016	AL TN		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	057	0		29	10	S0522_057_0	6		1	05/29/2015	2016.01	05/29/2015 10:20:07 AM Central Daylight Time		06/01/2015 01:22:06 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	057	0	2016	MI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	058	0		29	10	S0522_058_0	5		1	05/29/2015	2016.01	05/29/2015 10:20:24 AM Central Daylight Time		06/01/2015 01:45:52 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	058	0	2016	OH		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	059	0		29	10	S0522_059_0	5		1	05/29/2015	2016.01	05/29/2015 10:20:37 AM Central Daylight Time		06/01/2015 01:23:02 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	059	0	2016	IN KY		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	060	0		29	10	S0522_060_0	5		1	05/29/2015	2016.01	05/29/2015 10:20:56 AM Central Daylight Time		06/01/2015 01:24:10 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	060	0	2016	MS		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	061	0		29	10	S0522_061_0	5		1	05/29/2015	2016.01	05/29/2015 10:21:11 AM Central Daylight Time		06/01/2015 01:25:34 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	061	0	2016	LA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	062	0		29	10	S0522_062_0	5		1	05/29/2015	2016.01	05/29/2015 10:21:31 AM Central Daylight Time		06/01/2015 01:26:32 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	062	0	2016	CO		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	063	0		29	10	S0522_063_0	5		1	05/29/2015	2016.01	05/29/2015 10:21:44 AM Central Daylight Time		06/01/2015 01:27:04 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	063	0	2016	OR WA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	064	0		29	10	S0522_064_0	5		1	05/29/2015	2016.01	05/29/2015 10:21:57 AM Central Daylight Time		06/01/2015 01:27:42 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	064	0	2016	ID UT		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	065	0		29	10	S0522_065_0	5		1	05/29/2015	2016.01	05/29/2015 10:22:15 AM Central Daylight Time		06/01/2015 01:28:32 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	065	0	2016	CA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	066	0		29	10	S0522_066_0	5		1	05/29/2015	2016.01	05/29/2015 10:22:33 AM Central Daylight Time		06/01/2015 01:29:14 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	066	0	2016	WI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	067	0		29	10	S0522_067_0	5		1	05/29/2015	2016.01	05/29/2015 10:22:46 AM Central Daylight Time		06/01/2015 01:30:10 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	067	0	2016	MO		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	068	0		29	10	S0522_068_0	5		1	05/29/2015	2016.01	05/29/2015 10:22:59 AM Central Daylight Time		06/01/2015 01:30:46 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	068	0	2016	Arkansas		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	069	0		29	10	S0522_069_0	5		1	05/29/2015	2016.01	05/29/2015 10:23:13 AM Central Daylight Time		06/01/2015 01:31:30 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	069	0	2016	Texas		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	070	0		29	10	S0522_070_0	5		1	05/29/2015	2016.01	05/29/2015 10:23:25 AM Central Daylight Time		06/01/2015 01:32:16 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	070	0	2016	Oklahoma		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	071	0		29	10	S0522_071_0	5		1	05/29/2015	2016.01	05/29/2015 10:23:38 AM Central Daylight Time		06/01/2015 01:32:52 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	071	0	2016	KS		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	072	0		29	10	S0522_072_0	5		1	05/29/2015	2016.01	05/29/2015 10:23:51 AM Central Daylight Time		06/01/2015 01:33:34 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	072	0	2016	Upper Midwest and Northern Plains		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	073	0		29	10	S0522_073_0	5		1	05/29/2015	2016.01	05/29/2015 10:24:04 AM Central Daylight Time		06/01/2015 01:34:42 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	073	0	2016	NM		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	074	0		29	10	S0522_074_0	5		1	05/29/2015	2016.01	05/29/2015 10:24:18 AM Central Daylight Time		06/01/2015 01:36:02 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	074	0	2016	AZ		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	075	0		29	10	S0522_075_0	5		1	05/29/2015	2016.01	05/29/2015 10:24:31 AM Central Daylight Time		06/01/2015 01:36:36 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	075	0	2016	NV		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	076	0		29	10	S0522_076_0	5		1	05/29/2015	2016.01	05/29/2015 10:24:44 AM Central Daylight Time		06/01/2015 01:37:32 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	076	0	2016	Hawaii		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	077	0		29	10	S0522_077_0	5		1	05/29/2015	2016.01	05/29/2015 10:25:01 AM Central Daylight Time		06/01/2015 01:38:04 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	077	0	2016	Alaska		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	078	0		29	10	S0522_078_0	5		1	05/29/2015	2016.01	05/29/2015 10:16:10 AM Central Daylight Time		05/31/2015 11:48:18 AM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	078	0	2016	PA WV		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	079	0		29	10	S0522_079_0	5		1	05/28/2015	2016.01	05/28/2015 02:25:59 PM Central Daylight Time		05/31/2015 11:48:34 AM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	079	0	2016	Central New England - CT MA RI VT		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	080	0		29	10	S0522_080_0	5		1	05/29/2015	2016.01	05/29/2015 10:25:14 AM Central Daylight Time		06/01/2015 01:39:44 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	080	0	2016	PA WV		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	081	0		29	10	S0522_081_0	5		1	05/29/2015	2016.01	05/29/2015 10:25:30 AM Central Daylight Time		06/01/2015 01:40:12 PM Central Daylight Time			06/04/2015 04:37:49 PM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix PrimeSaver Rx (PDP)	10	29					S0522	081	0	2016	Central New England - CT MA RI VT		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0522	801	0		29	10	S0522_801_0	3		1	06/03/2015	2016.01	06/03/2015 09:30:27 AM Central Daylight Time					06/03/2015 09:30:36 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Protect Rx Drug Plan (PDP)	10	29					S0522	801	0	2016	All states except NY and FL		1					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(711)-		(711)-		(711)-		(711)-																
S0586	801	0		29	10	S0586_801_0	3		1	05/28/2015	2016.01	05/28/2015 10:12:52 AM Eastern Daylight Time					05/31/2015 08:19:48 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP Health Care	www.mvphealthcare.com	MVP RxCare - Employer Group (PDP)	10	29					S0586	801	0	2016	United States and Puerto Rico		1					2								www.mvphealthcare.com/medicare/PartD/partd_index.html	www.mvphealthcare.com/medicare/PartD/partd_index.html									(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
S0655	801	0		29	10	S0655_801_0	11		1	05/15/2015	2016.01	05/15/2015 02:27:09 PM Eastern Daylight Time					06/01/2015 04:29:18 PM Eastern Daylight Time	TUFTS INSURANCE COMPANY	Tufts Health Plan Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred PDP Group (PDP)	10	29					S0655	801	0	2016	Massachusetts and Nationwide		1					2								tuftsmedicarepreferred.org/druglist.php	tuftsmedicarepreferred.org/druglist.php									(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978																
S0655	802	0		29	10	S0655_802_0	11		1	05/01/2015	2016.01	05/01/2015 05:22:48 PM Eastern Daylight Time					06/01/2015 04:29:18 PM Eastern Daylight Time	TUFTS INSURANCE COMPANY	Tufts Health Plan Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred PDP Group (PDP)	10	29					S0655	802	0	2016	Massachusetts and Nationwide		1					2								tuftsmedicarepreferred.org/druglist.php	tuftsmedicarepreferred.org/druglist.php									(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8978		(888)899-8978																
S0764	801	0		29	10	S0764_801_0	3		1	05/27/2015	2016.01	05/27/2015 04:46:56 PM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	801	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S0764	802	0		29	10	S0764_802_0	3		1	05/27/2015	2016.01	05/27/2015 04:43:30 PM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	802	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S0764	803	0		29	10	S0764_803_0	3		1	05/27/2015	2016.01	05/27/2015 04:44:43 PM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	803	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S0764	804	0		29	10	S0764_804_0	3		1	05/27/2015	2016.01	05/27/2015 04:45:08 PM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	804	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S0764	805	0		29	10	S0764_805_0	3		1	05/27/2015	2016.01	05/27/2015 04:45:28 PM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	805	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S0764	806	0		29	10	S0764_806_0	3		1	05/27/2015	2016.01	05/27/2015 04:45:41 PM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	806	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S0764	807	0		29	10	S0764_807_0	3		1	05/29/2015	2016.01	05/29/2015 08:34:46 AM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	807	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S0764	808	0		29	10	S0764_808_0	3		1	05/27/2015	2016.01	05/27/2015 04:46:09 PM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	808	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S0764	809	0		29	10	S0764_809_0	3		1	05/27/2015	2016.01	05/27/2015 04:46:22 PM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	809	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S0764	810	0		29	10	S0764_810_0	2		1	05/27/2015	2016.01	05/27/2015 04:46:38 PM Central Daylight Time					05/30/2015 10:28:48 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare EGWP	http://www.magellanhealth.com/	Magellan Rx Medicare EGWP (PDP)	10	29					S0764	810	0	2016	Magellan Rx Medicare EGWP		1					2								https://mhs.magellanpharmacysolutions.com/coreportal/	https://mhs.magellanpharmacysolutions.com/coreportal/									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S1030	001	0		29	10	S1030_001_0	2		1	06/01/2015	2016.01	06/01/2015 01:57:42 PM Central Daylight Time		07/16/2015 09:26:30 AM Central Daylight Time			07/16/2015 09:33:57 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Option II (PDP)	10	29					S1030	001	0	2016	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	06/01/2015	2016.01	06/01/2015 08:39:36 AM Central Daylight Time		06/01/2015 09:51:08 AM Central Daylight Time			06/01/2015 02:32:18 PM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Option I (PDP)	10	29					S1030	006	0	2016	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	05/20/2015	2016.01	05/20/2015 03:53:54 PM Central Daylight Time					06/01/2015 02:32:18 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	2016	State of Alabama, State of Tennessee		1					2								www.bluerxalatenn.com	www.bluerxalatenn.com									(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	802	0		29	10	S1030_802_0	1		1	05/21/2015	2016.01	05/21/2015 12:51:58 PM Central Daylight Time					06/01/2015 02:39:57 PM 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	2016	State of Alabama, State of Tennessee		1					2								www.bluerxalatenn.com	www.bluerxalatenn.com									(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	803	0		29	10	S1030_803_0	1		1	05/08/2015	2016.01	05/08/2015 01:43:14 PM Central Daylight Time					06/01/2015 02:32:18 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	2016	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	05/20/2015	2016.01	05/20/2015 04:09:19 PM Central Daylight Time					06/01/2015 02:39:57 PM 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	2016	State of Alabama, State of Tennessee		1					2								www.bluerxalatenn.com	www.bluerxalatenn.com									(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1140	001	0		29	10	S1140_001_0	1		1	05/30/2015	2016.01	05/30/2015 05:27:40 PM Eastern Daylight Time		05/30/2015 12:47:17 PM Eastern Daylight Time			05/30/2015 05:29:39 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	HealthNow New York Inc.	www.healthnowny.com/medicare	SmartSaver Rx PDP Value (PDP)	10	29					S1140	001	0	2016	New York State		2					2								www.healthnowny.com/medicare	www.healthnowny.com/medicareoptions									(888)787-2390		(888)787-2390		(888)989-9905		(888)989-9905										(711)-		(711)-		(711)-		(711)-																
S1140	801	0		29	10	S1140_801_0	1		1	05/30/2015	2016.01	05/30/2015 05:27:59 PM Eastern Daylight Time					05/30/2015 05:29:39 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	HealthNow New York Inc.	www.healthnowny.com/medicareoptions	SmartSaver Rx EGWP PDP (PDP)	10	29					S1140	801	0	2016	New York State		1					2								www.healthnowny.com/medicare	www.healthnowny.com/medicare									(888)787-2390		(888)787-2390		(855)215-9232		(855)215-9232										(711)-		(711)-		(877)286-5710		(877)286-5710																
S1822	801	0		29	10	S1822_801_0	1		1	05/21/2015	2016.01	05/21/2015 03:19:19 PM Central Daylight Time					05/21/2015 04:38:49 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners National PDP	healthpartners.com/medicare	HealthPartners Retiree National Choice CY (PDP)	10	29					S1822	801	0	2016	Nationwide		1					2								healthpartners.com/medicarerx	healthpartners.com/medicare									(877)816-9539		(952)883-7373		(866)993-7428		(952)883-7428										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060																
S1822	802	0		29	10	S1822_802_0	1		1	05/21/2015	2016.01	05/21/2015 12:13:30 PM Central Daylight Time					05/21/2015 04:41:18 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners National PDP	healthpartners.com/medicare	HealthPartners Retiree National Choice NCY (PDP)	10	29					S1822	802	0	2016	Nationwide		1					2								healthpartners.com/medicarerx	healthpartners.com/medicare									(877)816-9539		(952)883-7373		(866)993-7428		(952)883-7428										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060																
S2468	003	0		29	10	S2468_003_0	2		1	05/31/2015	2016.01	05/31/2015 01:18:47 PM Pacific Daylight Time		05/31/2015 01:06:30 PM Pacific Daylight Time			05/31/2015 01:21:58 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare Basic Plan (PDP)	10	29					S2468	003	0	2016	State of California		2					2								www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy									(888)239-6469		(888)239-6469		(800)488-8000		(800)488-8000										(711)-		(711)-		(711)-		(711)-																
S2468	004	0		29	10	S2468_004_0	2		1	05/31/2015	2016.01	05/31/2015 12:50:45 PM Pacific Daylight Time		05/31/2015 01:05:42 PM Pacific Daylight Time			05/31/2015 01:24:19 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare Enhanced Plan (PDP)	10	29					S2468	004	0	2016	State of California		2					2								www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy									(888)239-6469		(888)239-6469		(800)488-8000		(800)488-8000										(711)-		(711)-		(711)-		(711)-																
S2468	801	0		29	10	S2468_801_0	1		1	05/21/2015	2016.01	05/21/2015 02:49:05 PM Pacific Daylight Time					05/31/2015 02:15:47 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	801	0	2016	PDP Employer Group Plan		1					2								www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy									(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	05/21/2015	2016.01	05/21/2015 02:49:29 PM Pacific Daylight Time					05/31/2015 02:17:10 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	802	0	2016	PDP Employer Group Plan		1					2								www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy									(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-																
S2505	001	0		29	10	S2505_001_0	5		1	05/31/2015	2016.01	05/31/2015 11:24:19 AM Eastern Daylight Time		07/14/2015 01:06:36 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	001	0	2016	Alabama and Tennessee		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S2505	003	0		29	10	S2505_003_0	5		1	05/31/2015	2016.01	05/31/2015 11:24:49 AM Eastern Daylight Time		07/14/2015 01:07:07 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	003	0	2016	Arkansas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S2505	005	0		29	10	S2505_005_0	5		1	05/31/2015	2016.01	05/31/2015 11:35:56 AM Eastern Daylight Time		07/14/2015 01:07:38 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	005	0	2016	Mississippi		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S2505	007	0		29	10	S2505_007_0	5		1	05/31/2015	2016.01	05/31/2015 11:27:25 AM Eastern Daylight Time		07/14/2015 01:08:07 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	007	0	2016	South Carolina		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S2505	009	0		29	10	S2505_009_0	5		1	05/31/2015	2016.01	05/31/2015 11:27:51 AM Eastern Daylight Time		07/14/2015 01:08:37 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	009	0	2016	Virginia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S2505	010	0		29	10	S2505_010_0	5		1	05/31/2015	2016.01	05/31/2015 11:36:24 AM Eastern Daylight Time		07/14/2015 01:09:09 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	010	0	2016	Missouri		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S2874	001	0		29	10	S2874_001_0	1		1	05/22/2015	2016.01	05/22/2015 02:08:09 PM Eastern Daylight Time		05/23/2015 12:05:50 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S2874	001	0	2016	Puerto Rico - Island Wide		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 02:08:40 PM Eastern Daylight Time		05/23/2015 12:06:22 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S2874	004	0	2016	Puerto Rico - Island Wide		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-																
S2874	801	0		29	10	S2874_801_0	1		1	05/13/2015	2016.01	05/13/2015 12:35:41 PM Eastern Daylight Time					05/26/2015 02:50:02 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PDP)	10	29					S2874	801	0	2016	Puerto Rico - Island Wide		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-																
S2893	001	0		29	10	S2893_001_0	4		1	06/01/2015	2016.01	06/01/2015 05:37:06 PM Eastern Daylight Time		06/01/2015 10:18:00 AM Eastern Daylight Time			06/01/2015 06:03:32 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Value Plus (PDP)	10	29					S2893	001	0	2016	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										(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069																
S2893	003	0		29	10	S2893_003_0	4		1	05/29/2015	2016.01	05/29/2015 12:11:16 PM Eastern Daylight Time		07/17/2015 08:43:21 AM Eastern Daylight Time			07/17/2015 01:19:28 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Premier (PDP)	10	29					S2893	003	0	2016	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										(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069																
S2893	801	0		29	10	S2893_801_0	1		1	04/29/2015	2016.01	04/29/2015 11:20:51 AM Eastern Daylight Time					05/27/2015 04:02:18 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	801	0	2016	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										(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069																
S2893	802	0		29	10	S2893_802_0	1		1	04/29/2015	2016.01	04/29/2015 11:21:36 AM Eastern Daylight Time					05/27/2015 04:04:54 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	802	0	2016	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										(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069																
S3389	802	0		29	10	S3389_802_0	2		1	05/28/2015	2016.01	05/28/2015 11:31:40 AM Eastern Daylight Time					05/28/2015 01:38:52 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	2016	States of Pennsylvania and West Virginia		1					2								https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/									(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629																
S3389	803	0		29	10	S3389_803_0	2		1	05/28/2015	2016.01	05/28/2015 11:32:44 AM Eastern Daylight Time					05/28/2015 01:38:52 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	2016	States of Pennsylvania and West Virginia		1					2								https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/									(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629																
S3474	801	0		29	10	S3474_801_0	1		1	05/18/2015	2016.01	05/18/2015 02:32:32 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	801	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	802	0		29	10	S3474_802_0	1		1	05/18/2015	2016.01	05/18/2015 02:32:50 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	802	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	804	0		29	10	S3474_804_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:04 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	804	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(844)363-1721		(844)363-1721		(844)363-1721		(844)363-1721										(711)-		(711)-		(711)-		(711)-																
S3474	805	0		29	10	S3474_805_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:13 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	805	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(844)363-1721		(844)363-1721		(844)363-1721		(844)363-1721										(711)-		(711)-		(711)-		(711)-																
S3474	806	0		29	10	S3474_806_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:19 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	806	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	807	0		29	10	S3474_807_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:24 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	807	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	808	0		29	10	S3474_808_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:29 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	808	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	809	0		29	10	S3474_809_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:35 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	809	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(844)363-1721		(844)363-1721		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	810	0		29	10	S3474_810_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:40 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	810	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	811	0		29	10	S3474_811_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:48 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	811	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	812	0		29	10	S3474_812_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:53 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	812	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	813	0		29	10	S3474_813_0	1		1	05/18/2015	2016.01	05/18/2015 02:33:59 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	813	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	814	0		29	10	S3474_814_0	1		1	05/18/2015	2016.01	05/18/2015 02:34:04 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	814	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	815	0		29	10	S3474_815_0	1		1	05/18/2015	2016.01	05/18/2015 02:34:54 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	815	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	816	0		29	10	S3474_816_0	1		1	05/18/2015	2016.01	05/18/2015 02:35:02 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	816	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3474	817	0		29	10	S3474_817_0	1		1	05/18/2015	2016.01	05/18/2015 02:35:08 PM Eastern Daylight Time					05/26/2015 09:51:49 AM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Precise RxCare	http://preciserxcare.amwins.com	Precise RxCare (PDP)	10	29					S3474	817	0	2016	All areas		1					2								http://preciserxcare.amwins.com/	http://preciserxcare.amwins.com/									(877)870-8560		(877)870-8560		(877)870-8560		(877)870-8560										(711)-		(711)-		(711)-		(711)-																
S3521	801	0		29	10	S3521_801_0	3		1	05/14/2015	2016.01	05/14/2015 09:05:01 AM Eastern Daylight Time					05/31/2015 08:44:00 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	2016	National and US Territories		1					2							www.SimplyPrescriptions.com	www.SimplyPrescriptions.com	www.SimplyPrescriptions.com									(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220																
S3875	802	0		29	10	S3875_802_0	1		1	05/27/2015	2016.01	05/27/2015 01:34:57 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	802	0	2016	Granite Alliance National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3875	803	0		29	10	S3875_803_0	1		1	05/27/2015	2016.01	05/27/2015 01:35:24 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance non-CY (PDP)	10	29					S3875	803	0	2016	Granite Alliance non-CY National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3875	804	0		29	10	S3875_804_0	1		1	05/27/2015	2016.01	05/27/2015 01:35:50 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - WellDyne (PDP)	10	29					S3875	804	0	2016	Granite Alliance - WellDyne National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3875	805	0		29	10	S3875_805_0	1		1	05/27/2015	2016.01	05/27/2015 01:36:08 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - WellDyne non-CY (PDP)	10	29					S3875	805	0	2016	Granite Alliance - WellDyne Non-CY National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3875	806	0		29	10	S3875_806_0	1		1	05/27/2015	2016.01	05/27/2015 01:36:18 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Maxor (PDP)	10	29					S3875	806	0	2016	Granite Alliance - Maxor National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3875	807	0		29	10	S3875_807_0	1		1	05/27/2015	2016.01	05/27/2015 01:36:31 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Maxor Non-CY (PDP)	10	29					S3875	807	0	2016	Granite Alliance - Maxor Non-CY National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3875	808	0		29	10	S3875_808_0	1		1	05/27/2015	2016.01	05/27/2015 01:36:48 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Prime (PDP)	10	29					S3875	808	0	2016	Granite Alliance - Prime National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3875	809	0		29	10	S3875_809_0	1		1	05/27/2015	2016.01	05/27/2015 01:37:09 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Prime Non-CY (PDP)	10	29					S3875	809	0	2016	Granite Alliance - Prime Non-CY National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3875	810	0		29	10	S3875_810_0	1		1	05/27/2015	2016.01	05/27/2015 01:37:23 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other (PDP)	10	29					S3875	810	0	2016	Granite Alliance - Other National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3875	811	0		29	10	S3875_811_0	1		1	05/27/2015	2016.01	05/27/2015 01:37:40 PM Mountain Daylight Time					05/27/2015 01:38:04 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other Non-CY (PDP)	10	29					S3875	811	0	2016	Granite Alliance - Other Non-CY National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-																
S3994	801	0		29	10	S3994_801_0	1		1	05/06/2015	2016.01	05/06/2015 12:59:59 PM Hawaiian Standard Time					05/29/2015 07:16:07 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	HMSA's Medicare Rx Plan	www.hmsa.com	Medicare Rx EGWP CY (PDP)	10	29					S3994	801	0	2016	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	05/29/2015	2016.01	05/29/2015 07:15:53 AM Hawaiian Standard Time					05/29/2015 07:19:09 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	HMSA's Medicare Rx Plan	www.hmsa.com	Medicare Rx EGWP NCY (PDP)	10	29					S3994	802	0	2016	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)-																
S4054	001	0		29	10	S4054_001_0	3		1	06/04/2015	2016.01	06/04/2015 04:17:19 PM Pacific Daylight Time		05/29/2015 12:20:01 PM Pacific Daylight Time			06/05/2015 08:35:48 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Medicare Rx Standard (PDP)	10	29					S4054	001	0	2016	State of Nevada		2					2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com									(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158										(711)-		(711)-		(711)-		(711)-																
S4054	002	0		29	10	S4054_002_0	7		1	06/04/2015	2016.01	06/04/2015 04:18:34 PM Pacific Daylight Time		07/07/2015 06:29:54 AM Pacific Daylight Time			07/07/2015 06:31:12 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Medicare Rx Choice (PDP)	10	29					S4054	002	0	2016	State of Nevada		2					2								www.SeniorCarePlus.com	www.SeniorCarePlus.com									(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158										(711)-		(711)-		(711)-		(711)-																
S4219	801	0		29	10	S4219_801_0	1		1	06/01/2015	2016.01	06/01/2015 08:03:06 AM Central Daylight Time					06/01/2015 08:07:01 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	2016	United States		1					2							www.Healthalliancemedicare.org	www.Healthalliancemedicare.org	www.Healthalliancemedicare.org									(855)291-9311		(855)291-9311		(888)382-9771		(888)382-9771										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844																
S4219	802	0		29	10	S4219_802_0	1		1	06/01/2015	2016.01	06/01/2015 08:03:13 AM Central Daylight Time					06/01/2015 08:07:01 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medicare Prescription Plan	www.Healthalliancemedicare.org	Medicare Employer PDP (PDP) - non calendar year (PDP)	10	29					S4219	802	0	2016	United States		1					2							www.Healthalliancemedicare.org	www.Healthalliancemedicare.org	www.Healthalliancemedicare.org									(855)291-9311		(855)291-9311		(888)382-9771		(888)382-9771										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844																
S4501	801	0		29	10	S4501_801_0	3		1	05/27/2015	2016.01	05/27/2015 09:29:39 AM Eastern Daylight Time					06/01/2015 02:46:12 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Healths Medicare Retiree Rx PDP	www.independenthealth.com	Independent Health's Medicare Retiree Rx (PDP)	10	29					S4501	801	0	2016	LMHF Program		1					2								www.independenthealth.com	www.pbdrx.com									(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840																
S4607	001	0		29	10	S4607_001_0	7		1	05/27/2015	2016.01	05/27/2015 04:26:45 PM Eastern Daylight Time		05/29/2015 08:18:29 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	001	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	002	0		29	10	S4607_002_0	2		1	05/27/2015	2016.01	05/27/2015 04:31:38 PM Eastern Daylight Time		05/29/2015 08:18:29 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	002	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	003	0		29	10	S4607_003_0	2		1	05/27/2015	2016.01	05/27/2015 04:34:33 PM Eastern Daylight Time		05/29/2015 08:18:29 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	003	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	008	0		29	10	S4607_008_0	2		1	05/27/2015	2016.01	05/27/2015 04:36:29 PM Eastern Daylight Time		05/29/2015 08:18:29 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	008	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	009	0		29	10	S4607_009_0	2		1	05/27/2015	2016.01	05/27/2015 04:38:17 PM Eastern Daylight Time		05/29/2015 08:18:29 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	009	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	010	0		29	10	S4607_010_0	2		1	05/27/2015	2016.01	05/27/2015 04:39:54 PM Eastern Daylight Time		05/29/2015 08:18:29 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	010	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	011	0		29	10	S4607_011_0	2		1	05/27/2015	2016.01	05/27/2015 04:41:28 PM Eastern Daylight Time		05/29/2015 08:18:30 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	011	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	012	0		29	10	S4607_012_0	2		1	05/27/2015	2016.01	05/27/2015 04:43:09 PM Eastern Daylight Time		05/29/2015 08:18:30 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	012	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	013	0		29	10	S4607_013_0	2		1	05/27/2015	2016.01	05/27/2015 04:45:03 PM Eastern Daylight Time		05/29/2015 08:18:30 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	013	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	014	0		29	10	S4607_014_0	2		1	05/27/2015	2016.01	05/27/2015 04:46:50 PM Eastern Daylight Time		05/29/2015 08:18:30 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	014	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	015	0		29	10	S4607_015_0	2		1	05/27/2015	2016.01	05/27/2015 04:48:27 PM Eastern Daylight Time		05/29/2015 08:18:30 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	015	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	016	0		29	10	S4607_016_0	2		1	05/27/2015	2016.01	05/27/2015 04:49:56 PM Eastern Daylight Time		05/29/2015 08:18:30 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	016	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	017	0		29	10	S4607_017_0	2		1	05/27/2015	2016.01	05/27/2015 04:51:27 PM Eastern Daylight Time		05/29/2015 08:18:30 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	017	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	018	0		29	10	S4607_018_0	2		1	05/27/2015	2016.01	05/27/2015 04:52:53 PM Eastern Daylight Time		05/29/2015 08:18:30 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	018	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	019	0		29	10	S4607_019_0	2		1	05/27/2015	2016.01	05/27/2015 04:54:34 PM Eastern Daylight Time		05/29/2015 08:18:31 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	019	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	020	0		29	10	S4607_020_0	2		1	05/27/2015	2016.01	05/27/2015 04:56:03 PM Eastern Daylight Time		05/29/2015 08:18:31 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	020	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	021	0		29	10	S4607_021_0	2		1	05/27/2015	2016.01	05/27/2015 04:57:31 PM Eastern Daylight Time		05/29/2015 08:18:31 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	021	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	022	0		29	10	S4607_022_0	2		1	05/27/2015	2016.01	05/27/2015 04:59:06 PM Eastern Daylight Time		05/29/2015 08:18:31 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	022	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	023	0		29	10	S4607_023_0	2		1	05/27/2015	2016.01	05/27/2015 05:00:36 PM Eastern Daylight Time		05/29/2015 08:18:31 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	023	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4607	024	0		29	10	S4607_024_0	2		1	05/27/2015	2016.01	05/27/2015 05:02:00 PM Eastern Daylight Time		05/29/2015 08:18:29 PM Eastern Daylight Time			05/30/2015 02:38:18 PM Eastern Daylight Time	MERIT HEALTH INSURANCE	Magellan Rx Medicare (PDP)	www.magellanhealth.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	024	0	2016	Magellan Rx Medicare Basic (PDP)		2					2								www.magellanhealth.com	www.magellanhealth.com									(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400										(800)659-4112		(480)624-9400		(800)659-4112		(480)624-9400																
S4802	012	0		29	10	S4802_012_0	7		1	05/31/2015	2016.01	05/31/2015 11:32:31 AM Eastern Daylight Time		07/14/2015 01:09:39 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	012	0	2016	Louisiana		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S4802	013	0		29	10	S4802_013_0	6		1	05/31/2015	2016.01	05/31/2015 11:35:20 AM Eastern Daylight Time		07/14/2015 01:10:10 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	013	0	2016	Texas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S4802	014	0		29	10	S4802_014_0	6		1	05/31/2015	2016.01	05/31/2015 11:36:56 AM Eastern Daylight Time		07/14/2015 01:10:41 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	014	0	2016	Oklahoma		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S4802	020	0		29	10	S4802_020_0	6		1	05/31/2015	2016.01	05/31/2015 11:34:18 AM Eastern Daylight Time		07/14/2015 01:11:10 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	020	0	2016	Oregon and Washington		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S4802	021	0		29	10	S4802_021_0	6		1	05/31/2015	2016.01	05/31/2015 11:33:40 AM Eastern Daylight Time		07/14/2015 01:11:39 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	021	0	2016	Idaho and Utah		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252																
S5351	801	0		29	10	S5351_801_0	2		1	05/30/2015	2016.01	05/30/2015 11:59:26 AM Central Daylight Time					05/31/2015 08:08:22 AM Central Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare 801 (PDP)	10	29					S5351	801	0	2016	Nationwide		1					2								http://medicare.pacificsource.com/Tools/DrugSearch.aspx	http://medicare.pacificsource.com/Tools/PharmacySearch.aspx									(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900																
S5450	801	0		29	10	S5450_801_0	1		1	05/30/2015	2016.01	05/30/2015 10:32:12 AM Eastern Daylight Time					06/01/2015 12:59:28 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	SecurityCare of Tennessee	www.bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	801	0	2016	39 PDP Regions		1					2								bcbst-medicare.com	bcbst-medicare.com									(800)831-2583		(800)831-2583		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	802	0		29	10	S5450_802_0	1		1	05/16/2015	2016.01	05/16/2015 10:10:03 PM Eastern Daylight Time					06/01/2015 12:59:28 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	SecurityCare of Tennessee	www.bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	802	0	2016	39 PDP Regions		1					2								bcbst-medicare.com	bcbst-medicare.com									(800)831-2583		(800)831-2583		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5540	002	0		29	10	S5540_002_0	5		1	05/26/2015	2016.01	05/26/2015 10:40:57 AM Eastern Daylight Time		08/03/2015 07:57:41 PM Eastern Daylight Time			08/03/2015 08:48:01 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare Rx Standard (PDP)	10	29					S5540	002	0	2016	North Carolina		2					2								http://www.bcbsnc.com/content/medicare/formulary-home.htm	http://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC									(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140																
S5540	004	0		29	10	S5540_004_0	5		1	05/20/2015	2016.01	05/20/2015 12:14:51 AM Eastern Daylight Time		08/03/2015 07:57:43 PM Eastern Daylight Time			08/03/2015 08:52:12 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare Rx Enhanced (PDP)	10	29					S5540	004	0	2016	North Carolina		2					2								http://www.bcbsnc.com/content/medicare/formulary-home.htm	http://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC									(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140																
S5540	801	0		29	10	S5540_801_0	3		1	04/30/2015	2016.01	04/30/2015 08:39:24 AM Eastern Daylight Time					05/28/2015 11:03:05 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare Rx EGWP (PDP)	10	29					S5540	801	0	2016	National Employer Group Retirees		1					2								http://www.bcbsnc.com/content/medicare/formulary-home.htm	http://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC									(888)247-4142		(888)247-4142		(800)478-0583		(800)478-0583										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140																
S5552	003	0		29	10	S5552_003_0	1		1	05/22/2015	2016.01	05/22/2015 02:09:41 PM Eastern Daylight Time		05/23/2015 12:06:54 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5552	003	0	2016	State of New York		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5552	004	0		29	10	S5552_004_0	1		1	05/22/2015	2016.01	05/22/2015 02:11:15 PM Eastern Daylight Time		05/23/2015 12:07:26 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5552	004	0	2016	State of New York		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5552	005	0		29	10	S5552_005_0	1		1	05/22/2015	2016.01	05/22/2015 02:11:40 PM Eastern Daylight Time		05/23/2015 12:07:58 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5552	005	0	2016	State of New York		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5552	801	0		29	10	S5552_801_0	1		1	05/13/2015	2016.01	05/13/2015 12:37:07 PM Eastern Daylight Time					05/26/2015 02:50:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PDP)	10	29					S5552	801	0	2016	State of New York		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5580	003	0		29	10	S5580_003_0	4		1	05/31/2015	2016.01	05/31/2015 09:56:19 PM Central Daylight Time		07/07/2015 06:03:48 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First United American - Enhanced (PDP)	10	29					S5580	003	0	2016	State of New York		2					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4171		(866)524-4171		(877)723-6067		(877)723-6067										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172																
S5580	006	0		29	10	S5580_006_0	5		1	05/29/2015	2016.01	05/29/2015 11:11:28 PM Central Daylight Time		07/08/2015 11:34:58 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First United American - Select (PDP)	10	29					S5580	006	0	2016	State of New York		2					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4171		(866)524-4171		(877)723-6067		(877)723-6067										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172																
S5580	007	0		29	10	S5580_007_0	6		1	06/30/2015	2016.01	06/30/2015 09:40:13 AM Central Daylight Time		07/08/2015 08:35:25 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First United American - Essential (PDP)	10	29					S5580	007	0	2016	State of New York		2					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4171		(866)524-4171		(877)723-6067		(877)723-6067										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172																
S5580	801	0		29	10	S5580_801_0	4		1	04/21/2015	2016.01	04/21/2015 04:56:11 PM Central Daylight Time					06/01/2015 06:41:31 AM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First UA Employer Calendar Drug Plan (PDP)	10	29					S5580	801	0	2016	National		1					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)412-8499		(866)412-8499		(866)412-8499		(866)412-8499										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172																
S5580	802	0		29	10	S5580_802_0	4		1	04/21/2015	2016.01	04/21/2015 04:56:19 PM Central Daylight Time					06/01/2015 06:41:31 AM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First UA Employer Non-Calendar Drug Plan (PDP)	10	29					S5580	802	0	2016	National		1					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)412-8499		(866)412-8499		(866)412-8499		(866)412-8499										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172																
S5580	805	0		29	10	S5580_805_0	4		1	04/21/2015	2016.01	04/21/2015 04:56:28 PM Central Daylight Time					06/01/2015 06:41:31 AM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First UA EGWP-Calendar Plan 2nd Formulary Opt. (PDP)	10	29					S5580	805	0	2016	National		1					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)412-8499		(866)412-8499		(866)412-8499		(866)412-8499										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172																
S5580	806	0		29	10	S5580_806_0	4		1	04/21/2015	2016.01	04/21/2015 04:56:34 PM Central Daylight Time					06/01/2015 06:41:31 AM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First UA EGWP-Non-Calendar Plan 2nd Formulary Opt. (PDP)	10	29					S5580	806	0	2016	National		1					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)412-8499		(866)412-8499		(866)412-8499		(866)412-8499										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172																
S5584	001	0		29	10	S5584_001_0	3		1	06/01/2015	2016.01	06/01/2015 08:42:30 AM Eastern Daylight Time		06/01/2015 07:47:01 PM Eastern Daylight Time			06/01/2015 08:43:12 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Option A (PDP)	10	29					S5584	001	0	2016	State of Michigan		2					2								www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare									(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-																
S5584	002	0		29	10	S5584_002_0	3		1	05/22/2015	2016.01	05/22/2015 12:48:55 PM Eastern Daylight Time		06/01/2015 07:47:16 PM Eastern Daylight Time			06/01/2015 08:43:12 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Option B (PDP)	10	29					S5584	002	0	2016	State of Michigan		2					2								www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare									(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-																
S5584	801	0		29	10	S5584_801_0	3		1	04/14/2015	2016.01	04/14/2015 03:10:47 PM Eastern Daylight Time					06/01/2015 08:43:12 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Employer Plan CY (PDP)	10	29					S5584	801	0	2016	State of Michigan		1					2								www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare									(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-																
S5584	802	0		29	10	S5584_802_0	3		1	04/14/2015	2016.01	04/14/2015 03:11:26 PM Eastern Daylight Time					06/01/2015 08:43:12 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Employer Plan non-CY (PDP)	10	29					S5584	802	0	2016	State of Michigan		1					2								www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare									(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-																
S5588	802	0		29	10	S5588_802_0	1		1	05/22/2015	2016.01	05/22/2015 09:05:43 AM Eastern Daylight Time					05/22/2015 03:17:25 PM Eastern Daylight Time	PARAMOUNT INSURANCE COMPANY	Paramount Prescription Drug Plan	www.paramounthealthcare.com	Paramount Std. Prescription Drug Plan Empl (PDP)	10	29					S5588	802	0	2016	Paramount Standard Prescription Drug Plan (Ohio)		1					2								www.paramounthealthcare.com/medicareplans	www.paramounthealthcare.com/medicareplans									(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670																
S5588	803	0		29	10	S5588_803_0	1		1	05/22/2015	2016.01	05/22/2015 09:05:54 AM Eastern Daylight Time					05/22/2015 03:17:25 PM Eastern Daylight Time	PARAMOUNT INSURANCE COMPANY	Paramount Prescription Drug Plan	www.paramounthealthcare.com	Paramount Enh. Prescription Drug Plan Empl (PDP)	10	29					S5588	803	0	2016	Paramount Enhanced Prescription Drug Plan (Ohio)		1					2								www.paramounthealthcare.com/medicareplans	www.paramounthealthcare.com/medicareplans									(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670																
S5593	002	0		29	10	S5593_002_0	5		1	05/29/2015	2016.01	05/29/2015 11:18:36 AM Eastern Daylight Time		06/01/2015 09:37:47 AM Eastern Daylight Time			06/01/2015 11:07:17 AM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	www.highmarkblueshield.com/medicare	Blue Rx PDP Plus (PDP)	10	29					S5593	002	0	2016	Pennsylvania  and West Virginia		2					2								http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare									(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(800)227-8210		(800)227-8210																
S5593	003	0		29	10	S5593_003_0	5		1	05/29/2015	2016.01	05/29/2015 11:23:24 AM Eastern Daylight Time		06/01/2015 09:38:13 AM Eastern Daylight Time			06/01/2015 11:07:17 AM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	www.highmarkblueshield.com/medicare	Blue Rx PDP Complete (PDP)	10	29					S5593	003	0	2016	Pennsylvania  and West Virginia		2					2								http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare									(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(800)227-8210		(800)227-8210																
S5593	801	0		29	10	S5593_801_0	5		1	04/23/2015	2016.01	04/23/2015 08:58:17 AM Eastern Daylight Time					06/01/2015 11:07:17 AM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	www.highmarkblueshield.com/medicare	Blue Rx PDP Employer Group Calendar (PDP)	10	29					S5593	801	0	2016	National		1					2								http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare									(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(800)227-8210		(800)227-8210																
S5593	802	0		29	10	S5593_802_0	5		1	04/14/2015	2016.01	04/14/2015 06:55:50 AM Eastern Daylight Time					06/01/2015 11:07:17 AM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	www.highmarkblueshield.com/medicare	Blue Rx PDP Employer Group Non-Calendar (PDP)	10	29					S5593	802	0	2016	National		1					2								http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare									(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(800)227-8210		(800)227-8210																
S5596	001	0		29	10	S5596_001_0	4		1	05/26/2015	2016.01	05/26/2015 05:24:24 PM Eastern Daylight Time		07/08/2015 12:17:03 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	001	0	2016	Maine and New Hampshire		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	003	0		29	10	S5596_003_0	4		1	05/26/2015	2016.01	05/26/2015 04:01:48 PM Eastern Daylight Time		07/08/2015 12:17:19 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	003	0	2016	Maine and New Hampshire		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	005	0		29	10	S5596_005_0	4		1	05/26/2015	2016.01	05/26/2015 09:17:28 AM Eastern Daylight Time		07/08/2015 12:17:36 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	005	0	2016	Virginia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	006	0		29	10	S5596_006_0	4		1	05/26/2015	2016.01	05/26/2015 05:28:48 PM Eastern Daylight Time		07/08/2015 12:17:53 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	006	0	2016	Virginia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	007	0		29	10	S5596_007_0	4		1	05/26/2015	2016.01	05/26/2015 04:02:55 PM Eastern Daylight Time		07/08/2015 12:18:09 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	007	0	2016	Virginia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	009	0		29	10	S5596_009_0	4		1	05/26/2015	2016.01	05/26/2015 09:54:00 AM Eastern Daylight Time		07/08/2015 12:18:26 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.bcbsga.com/medicare	BCBSGa Blue MedicareRx Standard (PDP)	10	29					S5596	009	0	2016	Georgia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	010	0		29	10	S5596_010_0	4		1	05/26/2015	2016.01	05/26/2015 09:23:16 AM Eastern Daylight Time		07/08/2015 12:18:43 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.bcbsga.com/medicare	BCBSGa Blue MedicareRx Plus (PDP)	10	29					S5596	010	0	2016	Georgia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	011	0		29	10	S5596_011_0	4		1	05/26/2015	2016.01	05/26/2015 04:04:08 PM Eastern Daylight Time		07/08/2015 12:19:00 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.bcbsga.com/medicare	BCBSGa Blue MedicareRx Premier (PDP)	10	29					S5596	011	0	2016	Georgia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	013	0		29	10	S5596_013_0	4		1	05/26/2015	2016.01	05/26/2015 09:26:31 AM Eastern Daylight Time		07/08/2015 12:19:16 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	013	0	2016	Ohio		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	014	0		29	10	S5596_014_0	4		1	05/26/2015	2016.01	05/26/2015 09:27:39 AM Eastern Daylight Time		07/08/2015 12:19:33 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	014	0	2016	Ohio		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	015	0		29	10	S5596_015_0	4		1	05/26/2015	2016.01	05/26/2015 04:05:11 PM Eastern Daylight Time		07/08/2015 12:19:50 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	015	0	2016	Ohio		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	017	0		29	10	S5596_017_0	4		1	05/26/2015	2016.01	05/26/2015 09:32:00 AM Eastern Daylight Time		07/08/2015 12:20:07 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	017	0	2016	Indiana and Kentucky		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	018	0		29	10	S5596_018_0	4		1	05/26/2015	2016.01	05/26/2015 09:32:31 AM Eastern Daylight Time		07/08/2015 12:20:24 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	018	0	2016	Indiana and Kentucky		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	019	0		29	10	S5596_019_0	5		1	05/26/2015	2016.01	05/26/2015 04:06:10 PM Eastern Daylight Time		07/08/2015 12:20:41 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	019	0	2016	Indiana and Kentucky		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	033	0		29	10	S5596_033_0	5		1	05/26/2015	2016.01	05/26/2015 09:34:37 AM Eastern Daylight Time		07/08/2015 12:20:59 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/ca/medicare	Anthem Blue Cross MedicareRx Standard (PDP)	10	29					S5596	033	0	2016	California		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	034	0		29	10	S5596_034_0	4		1	05/26/2015	2016.01	05/26/2015 09:35:32 AM Eastern Daylight Time		07/08/2015 12:21:15 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/ca/medicare	Anthem Blue Cross MedicareRx Plus (PDP)	10	29					S5596	034	0	2016	California		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	035	0		29	10	S5596_035_0	4		1	05/26/2015	2016.01	05/26/2015 04:07:12 PM Eastern Daylight Time		07/08/2015 12:21:32 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/ca/medicare	Anthem Blue Cross MedicareRx Gold (PDP)	10	29					S5596	035	0	2016	California		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	043	0		29	10	S5596_043_0	4		1	05/26/2015	2016.01	05/26/2015 09:37:22 AM Eastern Daylight Time		07/08/2015 12:21:49 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx Value (PDP)	10	29					S5596	043	0	2016	Missouri		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	044	0		29	10	S5596_044_0	4		1	05/26/2015	2016.01	05/26/2015 09:38:21 AM Eastern Daylight Time		07/08/2015 12:22:05 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx Plus (PDP)	10	29					S5596	044	0	2016	Missouri		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	045	0		29	10	S5596_045_0	4		1	05/26/2015	2016.01	05/26/2015 04:08:08 PM Eastern Daylight Time		07/08/2015 12:22:22 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx Premier (PDP)	10	29					S5596	045	0	2016	Missouri		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	046	0		29	10	S5596_046_0	4		1	05/26/2015	2016.01	05/26/2015 09:40:49 AM Eastern Daylight Time		07/08/2015 12:22:39 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	046	0	2016	Maine and New Hampshire		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	056	0		29	10	S5596_056_0	4		1	05/26/2015	2016.01	05/26/2015 12:56:21 PM Eastern Daylight Time		07/08/2015 12:22:56 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	056	0	2016	Wisconsin		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	057	0		29	10	S5596_057_0	4		1	05/26/2015	2016.01	05/26/2015 09:42:51 AM Eastern Daylight Time		07/08/2015 12:23:12 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	057	0	2016	Wisconsin		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	058	0		29	10	S5596_058_0	4		1	05/26/2015	2016.01	05/26/2015 04:09:05 PM Eastern Daylight Time		07/08/2015 12:23:29 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	058	0	2016	Wisconsin		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	059	0		29	10	S5596_059_0	4		1	05/26/2015	2016.01	05/26/2015 09:45:31 AM Eastern Daylight Time		07/08/2015 12:23:45 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	059	0	2016	Colorado		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	060	0		29	10	S5596_060_0	4		1	05/26/2015	2016.01	05/26/2015 09:46:25 AM Eastern Daylight Time		07/08/2015 12:24:02 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	060	0	2016	Colorado		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	061	0		29	10	S5596_061_0	4		1	05/26/2015	2016.01	05/26/2015 04:10:00 PM Eastern Daylight Time		07/08/2015 12:24:19 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	061	0	2016	Colorado		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	062	0		29	10	S5596_062_0	4		1	05/26/2015	2016.01	05/26/2015 09:48:25 AM Eastern Daylight Time		07/08/2015 12:24:35 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	062	0	2016	Nevada		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	063	0		29	10	S5596_063_0	5		1	05/26/2015	2016.01	05/26/2015 09:49:31 AM Eastern Daylight Time		07/08/2015 12:24:52 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	063	0	2016	Nevada		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	064	0		29	10	S5596_064_0	4		1	05/26/2015	2016.01	05/26/2015 04:10:56 PM Eastern Daylight Time		07/08/2015 12:25:09 PM Eastern Daylight Time			07/09/2015 02:34:08 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	064	0	2016	Nevada		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	803	0		29	10	S5596_803_0	4		1	05/22/2015	2016.01	05/22/2015 02:46:33 PM Eastern Daylight Time					06/01/2015 04:19:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	803	0	2016	VA GA OH IN KY WI CO NV CA MO ME NH (Nationwide)		1					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-																
S5596	804	0		29	10	S5596_804_0	4		1	05/22/2015	2016.01	05/22/2015 02:46:38 PM Eastern Daylight Time					06/01/2015 04:19:07 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	804	0	2016	VA GA OH IN KY WI CO NV CA MO ME NH (Nationwide)		1					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-																
S5601	002	0		29	10	S5601_002_0	6		1	07/15/2015	2016.01	07/15/2015 11:25:01 AM Eastern Daylight Time		07/23/2015 01:24:52 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	002	0	2016	Northern New England SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	003	0		29	10	S5601_003_0	6		1	06/05/2015	2016.01	06/05/2015 11:06:04 AM Eastern Daylight Time		07/23/2015 01:46:15 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	003	0	2016	Northern New England SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	004	0		29	10	S5601_004_0	5		1	05/19/2015	2016.01	05/19/2015 02:00:31 PM Eastern Daylight Time		07/23/2015 01:26:19 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	004	0	2016	Central New England SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	005	0		29	10	S5601_005_0	5		1	05/20/2015	2016.01	05/20/2015 01:47:15 PM Eastern Daylight Time		07/23/2015 01:45:44 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	005	0	2016	Central New England SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	006	0		29	10	S5601_006_0	5		1	05/21/2015	2016.01	05/21/2015 03:38:23 PM Eastern Daylight Time		07/23/2015 01:26:55 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	006	0	2016	New York SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	007	0		29	10	S5601_007_0	5		1	05/20/2015	2016.01	05/20/2015 01:48:09 PM Eastern Daylight Time		07/23/2015 01:45:14 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	007	0	2016	New York SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	008	0		29	10	S5601_008_0	5		1	05/19/2015	2016.01	05/19/2015 02:07:01 PM Eastern Daylight Time		07/23/2015 01:45:38 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	008	0	2016	New Jersey SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	009	0		29	10	S5601_009_0	5		1	05/20/2015	2016.01	05/20/2015 01:48:58 PM Eastern Daylight Time		07/23/2015 01:44:45 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	009	0	2016	New Jersey SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	010	0		29	10	S5601_010_0	5		1	05/19/2015	2016.01	05/19/2015 02:17:00 PM Eastern Daylight Time		07/23/2015 01:46:41 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	010	0	2016	Mid-Atlantic SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	011	0		29	10	S5601_011_0	5		1	05/20/2015	2016.01	05/20/2015 01:49:37 PM Eastern Daylight Time		07/23/2015 01:44:19 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	011	0	2016	Mid-Atlantic SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	012	0		29	10	S5601_012_0	5		1	05/22/2015	2016.01	05/22/2015 04:30:45 PM Eastern Daylight Time		07/23/2015 01:49:08 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	012	0	2016	Pennsylvania, West Virginia SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	013	0		29	10	S5601_013_0	5		1	05/20/2015	2016.01	05/20/2015 01:50:21 PM Eastern Daylight Time		07/23/2015 01:43:54 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	013	0	2016	Pennsylvania, West Virginia SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	014	0		29	10	S5601_014_0	5		1	05/19/2015	2016.01	05/19/2015 02:41:57 PM Eastern Daylight Time		07/23/2015 01:50:04 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	014	0	2016	Virginia SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	015	0		29	10	S5601_015_0	5		1	05/20/2015	2016.01	05/20/2015 01:51:08 PM Eastern Daylight Time		07/23/2015 01:43:26 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	015	0	2016	Virginia SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	016	0		29	10	S5601_016_0	5		1	05/19/2015	2016.01	05/19/2015 02:44:55 PM Eastern Daylight Time		07/23/2015 01:50:59 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	016	0	2016	North Carolina SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	017	0		29	10	S5601_017_0	5		1	05/20/2015	2016.01	05/20/2015 01:53:45 PM Eastern Daylight Time		07/23/2015 01:43:00 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	017	0	2016	North Carolina SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	018	0		29	10	S5601_018_0	6		1	05/19/2015	2016.01	05/19/2015 02:47:52 PM Eastern Daylight Time		07/23/2015 01:52:15 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	018	0	2016	South Carolina SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	019	0		29	10	S5601_019_0	5		1	05/20/2015	2016.01	05/20/2015 01:54:46 PM Eastern Daylight Time		07/23/2015 01:42:27 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	019	0	2016	South Carolina SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	020	0		29	10	S5601_020_0	5		1	05/19/2015	2016.01	05/19/2015 02:50:20 PM Eastern Daylight Time		07/23/2015 01:53:03 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	020	0	2016	Georgia SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	021	0		29	10	S5601_021_0	5		1	05/20/2015	2016.01	05/20/2015 01:55:37 PM Eastern Daylight Time		07/23/2015 01:41:37 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	021	0	2016	Georgia SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	022	0		29	10	S5601_022_0	5		1	05/19/2015	2016.01	05/19/2015 02:53:36 PM Eastern Daylight Time		07/23/2015 01:53:53 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	022	0	2016	Florida SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	023	0		29	10	S5601_023_0	5		1	05/20/2015	2016.01	05/20/2015 01:56:33 PM Eastern Daylight Time		07/23/2015 01:41:06 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	023	0	2016	Florida SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	024	0		29	10	S5601_024_0	5		1	05/19/2015	2016.01	05/19/2015 02:56:14 PM Eastern Daylight Time		07/23/2015 01:54:40 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	024	0	2016	Alabama, Tennessee SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	025	0		29	10	S5601_025_0	5		1	05/20/2015	2016.01	05/20/2015 01:57:22 PM Eastern Daylight Time		07/23/2015 01:40:42 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	025	0	2016	Alabama, Tennessee SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	026	0		29	10	S5601_026_0	5		1	05/19/2015	2016.01	05/19/2015 02:58:39 PM Eastern Daylight Time		07/23/2015 01:55:19 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	026	0	2016	Michigan SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	027	0		29	10	S5601_027_0	5		1	05/20/2015	2016.01	05/20/2015 01:58:08 PM Eastern Daylight Time		07/23/2015 01:40:12 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	027	0	2016	Michigan SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	028	0		29	10	S5601_028_0	5		1	05/29/2015	2016.01	05/29/2015 04:59:41 PM Eastern Daylight Time		07/23/2015 01:56:02 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	028	0	2016	Ohio SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	029	0		29	10	S5601_029_0	5		1	05/20/2015	2016.01	05/20/2015 01:59:00 PM Eastern Daylight Time		07/23/2015 01:39:40 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	029	0	2016	Ohio SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	030	0		29	10	S5601_030_0	5		1	05/19/2015	2016.01	05/19/2015 03:18:12 PM Eastern Daylight Time		07/23/2015 01:57:17 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	030	0	2016	Indiana, Kentucky SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	031	0		29	10	S5601_031_0	5		1	05/20/2015	2016.01	05/20/2015 01:59:47 PM Eastern Daylight Time		07/23/2015 01:46:53 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	031	0	2016	Indiana, Kentucky SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	032	0		29	10	S5601_032_0	5		1	05/19/2015	2016.01	05/19/2015 03:25:29 PM Eastern Daylight Time		07/23/2015 01:57:55 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	032	0	2016	Wisconsin SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	033	0		29	10	S5601_033_0	5		1	05/20/2015	2016.01	05/20/2015 02:00:40 PM Eastern Daylight Time		07/23/2015 02:00:47 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	033	0	2016	Wisconsin SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	034	0		29	10	S5601_034_0	5		1	05/22/2015	2016.01	05/22/2015 04:31:49 PM Eastern Daylight Time		07/23/2015 01:59:26 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	034	0	2016	Illinois SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	035	0		29	10	S5601_035_0	5		1	05/22/2015	2016.01	05/22/2015 04:42:29 PM Eastern Daylight Time		07/23/2015 02:00:22 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	035	0	2016	Illinois SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	036	0		29	10	S5601_036_0	5		1	05/20/2015	2016.01	05/20/2015 09:28:05 AM Eastern Daylight Time		07/23/2015 02:00:01 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	036	0	2016	Missouri SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	037	0		29	10	S5601_037_0	5		1	05/20/2015	2016.01	05/20/2015 02:02:22 PM Eastern Daylight Time		07/23/2015 01:59:58 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	037	0	2016	Missouri SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	038	0		29	10	S5601_038_0	5		1	05/22/2015	2016.01	05/22/2015 04:33:00 PM Eastern Daylight Time		07/23/2015 02:01:56 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	038	0	2016	Arkansas SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	040	0		29	10	S5601_040_0	5		1	05/20/2015	2016.01	05/20/2015 09:38:09 AM Eastern Daylight Time		07/23/2015 02:01:06 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	040	0	2016	Mississippi SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	041	0		29	10	S5601_041_0	5		1	05/20/2015	2016.01	05/20/2015 02:37:35 PM Eastern Daylight Time		07/23/2015 02:25:22 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	041	0	2016	Mississippi SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	042	0		29	10	S5601_042_0	5		1	05/20/2015	2016.01	05/20/2015 09:41:06 AM Eastern Daylight Time		07/23/2015 02:02:59 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	042	0	2016	Louisiana SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	044	0		29	10	S5601_044_0	5		1	05/20/2015	2016.01	05/20/2015 09:44:20 AM Eastern Daylight Time		07/23/2015 02:03:57 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	044	0	2016	Texas SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	045	0		29	10	S5601_045_0	5		1	05/20/2015	2016.01	05/20/2015 02:38:24 PM Eastern Daylight Time		07/23/2015 01:58:24 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	045	0	2016	Texas SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	046	0		29	10	S5601_046_0	5		1	05/20/2015	2016.01	05/20/2015 09:47:44 AM Eastern Daylight Time		07/23/2015 02:03:31 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	046	0	2016	Oklahoma SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	048	0		29	10	S5601_048_0	5		1	05/20/2015	2016.01	05/20/2015 09:50:18 AM Eastern Daylight Time		07/23/2015 02:06:17 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	048	0	2016	Kansas SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	049	0		29	10	S5601_049_0	5		1	05/20/2015	2016.01	05/20/2015 02:38:59 PM Eastern Daylight Time		07/23/2015 01:57:31 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	049	0	2016	Kansas SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	050	0		29	10	S5601_050_0	5		1	05/22/2015	2016.01	05/22/2015 04:34:36 PM Eastern Daylight Time		07/23/2015 02:05:03 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	050	0	2016	Upper Midwest and N. Plains SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	051	0		29	10	S5601_051_0	5		1	05/20/2015	2016.01	05/20/2015 02:40:26 PM Eastern Daylight Time		07/23/2015 01:56:56 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	051	0	2016	Upper Midwest and N. Plains SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	052	0		29	10	S5601_052_0	5		1	05/20/2015	2016.01	05/20/2015 09:58:48 AM Eastern Daylight Time		07/23/2015 02:05:29 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	052	0	2016	New Mexico SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	053	0		29	10	S5601_053_0	5		1	05/20/2015	2016.01	05/20/2015 02:41:09 PM Eastern Daylight Time		07/23/2015 01:56:05 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	053	0	2016	New Mexico SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	054	0		29	10	S5601_054_0	5		1	05/20/2015	2016.01	05/20/2015 10:03:37 AM Eastern Daylight Time		07/23/2015 02:09:16 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	054	0	2016	Colorado SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	055	0		29	10	S5601_055_0	5		1	05/20/2015	2016.01	05/20/2015 02:41:49 PM Eastern Daylight Time		07/23/2015 01:55:30 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	055	0	2016	Colorado SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	056	0		29	10	S5601_056_0	5		1	05/20/2015	2016.01	05/20/2015 11:31:20 AM Eastern Daylight Time		07/23/2015 02:07:27 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	056	0	2016	Arizona SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	057	0		29	10	S5601_057_0	5		1	05/20/2015	2016.01	05/20/2015 02:42:48 PM Eastern Daylight Time		07/23/2015 01:54:55 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	057	0	2016	Arizona SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	058	0		29	10	S5601_058_0	5		1	05/20/2015	2016.01	05/20/2015 11:34:06 AM Eastern Daylight Time		07/23/2015 02:07:58 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	058	0	2016	Nevada SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	059	0		29	10	S5601_059_0	5		1	05/20/2015	2016.01	05/20/2015 02:43:35 PM Eastern Daylight Time		07/23/2015 01:54:10 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	059	0	2016	Nevada SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	060	0		29	10	S5601_060_0	5		1	05/22/2015	2016.01	05/22/2015 04:35:34 PM Eastern Daylight Time		07/23/2015 02:08:33 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	060	0	2016	Oregon, Washington SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	061	0		29	10	S5601_061_0	5		1	05/20/2015	2016.01	05/20/2015 02:44:08 PM Eastern Daylight Time		07/23/2015 02:01:13 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	061	0	2016	Oregon, Washington SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	062	0		29	10	S5601_062_0	5		1	05/22/2015	2016.01	05/22/2015 04:36:29 PM Eastern Daylight Time		07/23/2015 02:11:12 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	062	0	2016	Idaho, Utah SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	063	0		29	10	S5601_063_0	5		1	05/20/2015	2016.01	05/20/2015 02:48:17 PM Eastern Daylight Time		07/23/2015 02:03:23 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	063	0	2016	Idaho, Utah SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	064	0		29	10	S5601_064_0	5		1	05/22/2015	2016.01	05/22/2015 04:39:30 PM Eastern Daylight Time		07/23/2015 02:10:45 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	064	0	2016	California SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	065	0		29	10	S5601_065_0	5		1	05/20/2015	2016.01	05/20/2015 02:45:18 PM Eastern Daylight Time		07/23/2015 02:02:59 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	065	0	2016	California SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	066	0		29	10	S5601_066_0	6		1	05/20/2015	2016.01	05/20/2015 11:49:20 AM Eastern Daylight Time		07/23/2015 02:11:47 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	066	0	2016	Hawaii SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	067	0		29	10	S5601_067_0	6		1	05/29/2015	2016.01	05/29/2015 05:10:57 PM Eastern Daylight Time		07/23/2015 02:03:50 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	067	0	2016	Hawaii SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	068	0		29	10	S5601_068_0	5		1	05/29/2015	2016.01	05/29/2015 05:03:06 PM Eastern Daylight Time		07/23/2015 02:10:20 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	068	0	2016	Alaska SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	107	0		29	10	S5601_107_0	5		1	05/20/2015	2016.01	05/20/2015 02:46:47 PM Eastern Daylight Time		07/23/2015 02:27:10 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	107	0	2016	Arkansas SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	108	0		29	10	S5601_108_0	5		1	05/22/2015	2016.01	05/22/2015 04:43:49 PM Eastern Daylight Time		07/23/2015 02:24:31 PM Eastern Daylight Time			07/23/2015 06:04:17 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	108	0	2016	Louisiana SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	109	0		29	10	S5601_109_0	4		1	05/22/2015	2016.01	05/22/2015 04:44:56 PM Eastern Daylight Time		07/23/2015 02:26:31 PM Eastern Daylight Time			07/23/2015 05:01:39 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	109	0	2016	Oklahoma SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	801	0		29	10	S5601_801_0	1		1	05/26/2015	2016.01	05/26/2015 03:45:20 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 3 Tier - Calendar (PDP)	10	29					S5601	801	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	802	0		29	10	S5601_802_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:15 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 3 Tier - Non-Calendar (PDP)	10	29					S5601	802	0	2016	National SilverScript Group - Non-Calendar		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	803	0		29	10	S5601_803_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:20 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 2 Tier - Calendar (PDP)	10	29					S5601	803	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	804	0		29	10	S5601_804_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:25 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 2 Tier - Non-Calendar (PDP)	10	29					S5601	804	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	805	0		29	10	S5601_805_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:29 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 1 Tier - Calendar (PDP)	10	29					S5601	805	0	2016	National		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	806	0		29	10	S5601_806_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:33 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 1 Tier - Non Calendar (PDP)	10	29					S5601	806	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	807	0		29	10	S5601_807_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:37 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 4 Tier - Calendar (PDP)	10	29					S5601	807	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	808	0		29	10	S5601_808_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:41 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 4 Tier - Non Calendar (PDP)	10	29					S5601	808	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	809	0		29	10	S5601_809_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:45 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 5 Tier - Calendar (PDP)	10	29					S5601	809	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	810	0		29	10	S5601_810_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:50 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 5 Tier - Non Calendar (PDP)	10	29					S5601	810	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	811	0		29	10	S5601_811_0	1		1	05/28/2015	2016.01	05/28/2015 03:12:55 PM Eastern Daylight Time					05/28/2015 03:13:26 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - State of NY (PDP)	10	29					S5601	811	0	2016	National		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	812	0		29	10	S5601_812_0	1		1	05/29/2015	2016.01	05/29/2015 04:03:39 PM Eastern Daylight Time					05/29/2015 04:04:12 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript SF Group - 3 Tier - Calendar (PDP)	10	29					S5601	812	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	813	0		29	10	S5601_813_0	1		1	05/29/2015	2016.01	05/29/2015 04:03:44 PM Eastern Daylight Time					05/29/2015 04:04:12 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript SF Group - 4 Tier - Calendar (PDP)	10	29					S5601	813	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	814	0		29	10	S5601_814_0	1		1	05/29/2015	2016.01	05/29/2015 04:03:48 PM Eastern Daylight Time					05/29/2015 04:04:12 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript SF Group - 4 Tier - Calendar (PDP)	10	29					S5601	814	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5601	815	0		29	10	S5601_815_0	1		1	05/29/2015	2016.01	05/29/2015 04:03:53 PM Eastern Daylight Time					05/29/2015 04:04:12 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript SF Group - 4 Tier - Calendar (PDP)	10	29					S5601	815	0	2016	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)552-6288		(866)552-6288		(866)552-6288		(866)552-6288																
S5609	001	0		29	10	S5609_001_0	3		1	06/01/2015	2016.01	06/01/2015 11:22:10 AM Mountain Daylight Time		06/01/2015 03:31:06 PM Mountain Daylight Time			06/01/2015 05:04:35 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Basic (PDP)	10	29					S5609	001	0	2016	Region of Oregon and Washington		2					2								www.asuris.com/medicare	www.asuris.com/medicare									(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172										(711)-		(711)-		(711)-		(711)-																
S5609	002	0		29	10	S5609_002_0	4		1	06/01/2015	2016.01	06/01/2015 11:22:33 AM Mountain Daylight Time		07/20/2015 09:59:47 AM Mountain Daylight Time			07/20/2015 11:11:25 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Enhanced (PDP)	10	29					S5609	002	0	2016	Region of Oregon and Washington		2					2								www.asuris.com/medicare	www.asuris.com/medicare									(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172										(711)-		(711)-		(711)-		(711)-																
S5609	802	0		29	10	S5609_802_0	2		1	04/29/2015	2016.01	04/29/2015 12:51:45 PM Mountain Daylight Time					06/01/2015 05:04:35 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script (PDP)	10	29					S5609	802	0	2016	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	5		1	05/24/2015	2016.01	05/24/2015 01:21:16 PM Eastern Daylight Time		07/09/2015 05:09:12 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	003	0	2016	New Hampshire and Maine		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	008	0		29	10	S5617_008_0	4		1	05/24/2015	2016.01	05/24/2015 01:30:03 PM Eastern Daylight Time		07/09/2015 05:09:32 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	008	0	2016	Connecticut, Massachusetts, Rhode Island, Vermont		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	013	0		29	10	S5617_013_0	4		1	05/25/2015	2016.01	05/25/2015 06:52:55 PM Eastern Daylight Time		07/09/2015 05:09:52 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	013	0	2016	New York		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	018	0		29	10	S5617_018_0	4		1	05/24/2015	2016.01	05/24/2015 01:47:20 PM Eastern Daylight Time		07/09/2015 05:10:12 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	018	0	2016	New Jersey		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	053	0		29	10	S5617_053_0	4		1	05/24/2015	2016.01	05/24/2015 05:07:58 PM Eastern Daylight Time		07/09/2015 05:10:32 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	053	0	2016	Florida		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	068	0		29	10	S5617_068_0	4		1	05/24/2015	2016.01	05/24/2015 05:27:58 PM Eastern Daylight Time		07/09/2015 05:10:52 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	068	0	2016	Ohio		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	088	0		29	10	S5617_088_0	4		1	05/24/2015	2016.01	05/24/2015 06:05:25 PM Eastern Daylight Time		07/09/2015 05:11:12 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	088	0	2016	Missouri		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	103	0		29	10	S5617_103_0	4		1	05/24/2015	2016.01	05/24/2015 06:34:12 PM Eastern Daylight Time		07/09/2015 05:11:32 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	103	0	2016	Louisiana		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	108	0		29	10	S5617_108_0	4		1	05/24/2015	2016.01	05/24/2015 06:40:07 PM Eastern Daylight Time		07/09/2015 05:11:50 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	108	0	2016	Texas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	113	0		29	10	S5617_113_0	4		1	05/24/2015	2016.01	05/24/2015 07:22:55 PM Eastern Daylight Time		07/09/2015 05:12:10 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	113	0	2016	Oklahoma		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	118	0		29	10	S5617_118_0	4		1	05/24/2015	2016.01	05/24/2015 07:29:36 PM Eastern Daylight Time		07/09/2015 05:12:30 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	118	0	2016	Kansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	123	0		29	10	S5617_123_0	4		1	05/24/2015	2016.01	05/24/2015 07:33:36 PM Eastern Daylight Time		07/09/2015 05:12:50 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	123	0	2016	IA, MN, MT, ND, NE, SD, WY		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	128	0		29	10	S5617_128_0	4		1	05/24/2015	2016.01	05/24/2015 07:37:59 PM Eastern Daylight Time		07/09/2015 05:13:10 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	128	0	2016	New Mexico		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	133	0		29	10	S5617_133_0	4		1	05/24/2015	2016.01	05/24/2015 07:42:46 PM Eastern Daylight Time		07/09/2015 05:13:30 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	133	0	2016	Colorado		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	138	0		29	10	S5617_138_0	4		1	05/24/2015	2016.01	05/24/2015 07:55:57 PM Eastern Daylight Time		07/09/2015 05:13:50 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	138	0	2016	Arizona		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	143	0		29	10	S5617_143_0	4		1	05/24/2015	2016.01	05/24/2015 08:13:50 PM Eastern Daylight Time		07/09/2015 05:14:10 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	143	0	2016	Nevada		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	148	0		29	10	S5617_148_0	4		1	05/24/2015	2016.01	05/24/2015 08:18:23 PM Eastern Daylight Time		07/09/2015 05:14:30 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	148	0	2016	Oregon and Washington		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	153	0		29	10	S5617_153_0	4		1	05/24/2015	2016.01	05/24/2015 08:23:35 PM Eastern Daylight Time		07/09/2015 05:14:48 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	153	0	2016	Idaho and Utah		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	158	0		29	10	S5617_158_0	4		1	05/24/2015	2016.01	05/24/2015 08:27:39 PM Eastern Daylight Time		07/09/2015 05:15:08 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	158	0	2016	California		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	163	0		29	10	S5617_163_0	4		1	05/24/2015	2016.01	05/24/2015 08:31:59 PM Eastern Daylight Time		07/09/2015 05:15:28 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	163	0	2016	Hawaii		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	214	0		29	10	S5617_214_0	4		1	05/24/2015	2016.01	05/24/2015 02:07:45 PM Eastern Daylight Time		07/09/2015 05:15:48 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	214	0	2016	Delaware, Maryland and District of Columbia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	215	0		29	10	S5617_215_0	4		1	05/24/2015	2016.01	05/24/2015 02:12:28 PM Eastern Daylight Time		07/09/2015 05:16:08 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	215	0	2016	Pennsylvania and West Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	216	0		29	10	S5617_216_0	4		1	05/24/2015	2016.01	05/24/2015 02:21:04 PM Eastern Daylight Time		07/09/2015 05:16:28 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	216	0	2016	Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	217	0		29	10	S5617_217_0	4		1	05/24/2015	2016.01	05/24/2015 02:24:20 PM Eastern Daylight Time		07/09/2015 05:16:48 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	217	0	2016	North Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	218	0		29	10	S5617_218_0	4		1	05/24/2015	2016.01	05/24/2015 02:25:11 PM Eastern Daylight Time		07/09/2015 05:17:10 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	218	0	2016	South Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	219	0		29	10	S5617_219_0	4		1	05/24/2015	2016.01	05/24/2015 02:37:34 PM Eastern Daylight Time		07/09/2015 05:17:30 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	219	0	2016	Georgia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	220	0		29	10	S5617_220_0	4		1	05/24/2015	2016.01	05/24/2015 05:18:15 PM Eastern Daylight Time		07/09/2015 05:17:48 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	220	0	2016	Alabama and Tennessee		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	221	0		29	10	S5617_221_0	4		1	05/24/2015	2016.01	05/24/2015 05:23:27 PM Eastern Daylight Time		07/09/2015 05:18:08 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	221	0	2016	Michigan		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	222	0		29	10	S5617_222_0	4		1	05/24/2015	2016.01	05/24/2015 05:32:59 PM Eastern Daylight Time		07/09/2015 05:18:28 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	222	0	2016	Indiana and Kentucky		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	223	0		29	10	S5617_223_0	4		1	05/24/2015	2016.01	05/24/2015 05:40:01 PM Eastern Daylight Time		07/09/2015 05:18:48 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	223	0	2016	Wisconsin		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	224	0		29	10	S5617_224_0	4		1	05/24/2015	2016.01	05/24/2015 05:56:47 PM Eastern Daylight Time		07/09/2015 05:19:08 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	224	0	2016	Illinois		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	225	0		29	10	S5617_225_0	4		1	05/24/2015	2016.01	05/24/2015 06:09:54 PM Eastern Daylight Time		07/09/2015 05:19:28 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	225	0	2016	Arkansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	226	0		29	10	S5617_226_0	4		1	05/24/2015	2016.01	05/24/2015 06:11:35 PM Eastern Daylight Time		07/09/2015 05:19:48 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	226	0	2016	Mississippi		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	227	0		29	10	S5617_227_0	6		1	05/24/2015	2016.01	05/24/2015 08:36:03 PM Eastern Daylight Time		07/09/2015 05:20:08 PM Central Daylight Time			07/13/2015 01:41:34 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	227	0	2016	Alaska		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	246	0		29	10	S5617_246_0	5		1	05/26/2015	2016.01	05/26/2015 10:20:05 AM Eastern Daylight Time		07/09/2015 05:20:28 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	246	0	2016	New Hampshire and Maine		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	247	0		29	10	S5617_247_0	4		1	05/26/2015	2016.01	05/26/2015 10:18:36 AM Eastern Daylight Time		07/09/2015 05:20:48 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	247	0	2016	Connecticut, Massachusetts, Rhode Island, Vermont		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	248	0		29	10	S5617_248_0	4		1	05/26/2015	2016.01	05/26/2015 10:21:12 AM Eastern Daylight Time		07/09/2015 05:21:08 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	248	0	2016	New York		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	249	0		29	10	S5617_249_0	4		1	05/26/2015	2016.01	05/26/2015 10:26:22 AM Eastern Daylight Time		07/09/2015 05:21:28 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	249	0	2016	New Jersey		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	250	0		29	10	S5617_250_0	4		1	05/26/2015	2016.01	05/26/2015 10:29:01 AM Eastern Daylight Time		07/09/2015 05:21:48 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	250	0	2016	Delaware, Maryland and District of Columbia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	251	0		29	10	S5617_251_0	4		1	05/26/2015	2016.01	05/26/2015 10:32:24 AM Eastern Daylight Time		07/09/2015 05:22:08 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	251	0	2016	Pennsylvania and West Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	252	0		29	10	S5617_252_0	4		1	05/26/2015	2016.01	05/26/2015 10:33:33 AM Eastern Daylight Time		07/09/2015 05:22:28 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	252	0	2016	Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	253	0		29	10	S5617_253_0	4		1	05/26/2015	2016.01	05/26/2015 10:34:27 AM Eastern Daylight Time		07/09/2015 05:22:48 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	253	0	2016	North Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	254	0		29	10	S5617_254_0	4		1	05/26/2015	2016.01	05/26/2015 10:35:25 AM Eastern Daylight Time		07/09/2015 05:23:06 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	254	0	2016	South Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	255	0		29	10	S5617_255_0	4		1	05/26/2015	2016.01	05/26/2015 10:05:13 AM Eastern Daylight Time		07/09/2015 05:23:26 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	255	0	2016	Georgia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	256	0		29	10	S5617_256_0	4		1	05/26/2015	2016.01	05/26/2015 10:36:29 AM Eastern Daylight Time		07/09/2015 05:23:46 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	256	0	2016	Florida		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	257	0		29	10	S5617_257_0	4		1	05/26/2015	2016.01	05/26/2015 10:37:29 AM Eastern Daylight Time		07/09/2015 05:24:06 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	257	0	2016	Alabama and Tennessee		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	258	0		29	10	S5617_258_0	4		1	05/26/2015	2016.01	05/26/2015 10:38:28 AM Eastern Daylight Time		07/09/2015 05:24:26 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	258	0	2016	Michigan		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	259	0		29	10	S5617_259_0	4		1	05/26/2015	2016.01	05/26/2015 10:39:23 AM Eastern Daylight Time		07/09/2015 05:24:46 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	259	0	2016	Ohio		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	260	0		29	10	S5617_260_0	4		1	05/26/2015	2016.01	05/26/2015 10:40:39 AM Eastern Daylight Time		07/09/2015 05:25:08 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	260	0	2016	Indiana and Kentucky		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	261	0		29	10	S5617_261_0	4		1	05/26/2015	2016.01	05/26/2015 10:41:27 AM Eastern Daylight Time		07/09/2015 05:25:28 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	261	0	2016	Wisconsin		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	262	0		29	10	S5617_262_0	4		1	05/26/2015	2016.01	05/26/2015 10:46:05 AM Eastern Daylight Time		07/09/2015 05:25:48 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	262	0	2016	Illinois		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	263	0		29	10	S5617_263_0	4		1	05/26/2015	2016.01	05/26/2015 10:45:40 AM Eastern Daylight Time		07/09/2015 05:26:08 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	263	0	2016	Missouri		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	264	0		29	10	S5617_264_0	4		1	05/26/2015	2016.01	05/26/2015 10:46:50 AM Eastern Daylight Time		07/09/2015 05:26:28 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	264	0	2016	Arkansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	265	0		29	10	S5617_265_0	4		1	05/26/2015	2016.01	05/26/2015 10:47:39 AM Eastern Daylight Time		07/09/2015 05:26:50 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	265	0	2016	Mississippi		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	266	0		29	10	S5617_266_0	4		1	05/26/2015	2016.01	05/26/2015 10:48:44 AM Eastern Daylight Time		07/09/2015 05:27:08 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	266	0	2016	Louisiana		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	267	0		29	10	S5617_267_0	4		1	05/26/2015	2016.01	05/26/2015 10:49:54 AM Eastern Daylight Time		07/09/2015 05:27:30 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	267	0	2016	Texas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	268	0		29	10	S5617_268_0	4		1	05/26/2015	2016.01	05/26/2015 10:50:42 AM Eastern Daylight Time		07/09/2015 05:27:48 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	268	0	2016	Oklahoma		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	269	0		29	10	S5617_269_0	4		1	05/26/2015	2016.01	05/26/2015 10:54:51 AM Eastern Daylight Time		07/09/2015 05:28:08 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	269	0	2016	Kansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	270	0		29	10	S5617_270_0	4		1	05/26/2015	2016.01	05/26/2015 10:55:51 AM Eastern Daylight Time		07/09/2015 05:28:28 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	270	0	2016	IA, MN, MT, ND, SD, NE, WY		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	271	0		29	10	S5617_271_0	4		1	05/26/2015	2016.01	05/26/2015 10:56:46 AM Eastern Daylight Time		07/09/2015 05:28:48 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	271	0	2016	New Mexico		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	272	0		29	10	S5617_272_0	4		1	05/26/2015	2016.01	05/26/2015 11:00:42 AM Eastern Daylight Time		07/09/2015 05:29:08 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	272	0	2016	Colorado		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	273	0		29	10	S5617_273_0	4		1	05/26/2015	2016.01	05/26/2015 11:01:33 AM Eastern Daylight Time		07/09/2015 05:29:28 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	273	0	2016	Arizona		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	274	0		29	10	S5617_274_0	4		1	05/26/2015	2016.01	05/26/2015 11:01:59 AM Eastern Daylight Time		07/09/2015 05:29:48 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	274	0	2016	Nevada		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	275	0		29	10	S5617_275_0	4		1	05/26/2015	2016.01	05/26/2015 11:07:58 AM Eastern Daylight Time		07/09/2015 05:30:08 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	275	0	2016	Oregon and Washington		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	276	0		29	10	S5617_276_0	4		1	05/26/2015	2016.01	05/26/2015 11:11:19 AM Eastern Daylight Time		07/09/2015 05:30:28 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	276	0	2016	Idaho and Utah		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	277	0		29	10	S5617_277_0	4		1	05/26/2015	2016.01	05/26/2015 11:12:48 AM Eastern Daylight Time		07/09/2015 05:30:48 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	277	0	2016	California		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	278	0		29	10	S5617_278_0	4		1	05/26/2015	2016.01	05/26/2015 11:13:44 AM Eastern Daylight Time		07/09/2015 05:31:08 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	278	0	2016	Hawaii		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	279	0		29	10	S5617_279_0	4		1	05/26/2015	2016.01	05/26/2015 11:14:47 AM Eastern Daylight Time		07/09/2015 05:31:28 PM Central Daylight Time			07/13/2015 01:48:19 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	279	0	2016	Alaska		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	801	0		29	10	S5617_801_0	2		1	05/25/2015	2016.01	05/25/2015 02:54:03 PM Central Daylight Time					06/01/2015 06:53:25 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan CY (PDP)	10	29					S5617	801	0	2016	Nationwide		1					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-																
S5617	802	0		29	10	S5617_802_0	3		1	05/25/2015	2016.01	05/25/2015 02:54:28 PM Central Daylight Time					06/01/2015 06:53:25 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan NCY (PDP)	10	29					S5617	802	0	2016	Nationwide		1					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-																
S5617	805	0		29	10	S5617_805_0	3		1	05/25/2015	2016.01	05/25/2015 02:54:37 PM Central Daylight Time					06/01/2015 06:53:25 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan CY (PDP)	10	29					S5617	805	0	2016	Nationwide		1					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-																
S5617	806	0		29	10	S5617_806_0	3		1	05/25/2015	2016.01	05/25/2015 02:54:44 PM Central Daylight Time					06/01/2015 06:53:25 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan NCY (PDP)	10	29					S5617	806	0	2016	Nationwide		1					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-																
S5660	104	0		29	10	S5660_104_0	1		1	05/30/2015	2016.01	05/30/2015 03:05:25 PM Eastern Daylight Time		05/29/2015 11:54:22 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	104	0	2016	Northern New England		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	105	0		29	10	S5660_105_0	1		1	05/27/2015	2016.01	05/27/2015 04:18:12 PM Eastern Daylight Time		05/29/2015 11:54:52 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	105	0	2016	Central New England		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	106	0		29	10	S5660_106_0	1		1	05/27/2015	2016.01	05/27/2015 04:18:28 PM Eastern Daylight Time		05/29/2015 11:55:20 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	106	0	2016	State of New Jersey		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	107	0		29	10	S5660_107_0	1		1	05/27/2015	2016.01	05/27/2015 04:18:52 PM Eastern Daylight Time		05/29/2015 11:55:50 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	107	0	2016	Mid-Atlantic		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	108	0		29	10	S5660_108_0	1		1	05/27/2015	2016.01	05/27/2015 04:19:13 PM Eastern Daylight Time		05/29/2015 11:56:20 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	108	0	2016	States of Pennsylvania and West Virginia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	109	0		29	10	S5660_109_0	1		1	05/27/2015	2016.01	05/27/2015 04:19:42 PM Eastern Daylight Time		05/29/2015 11:56:48 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	109	0	2016	State of Virginia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	110	0		29	10	S5660_110_0	1		1	05/27/2015	2016.01	05/27/2015 04:20:00 PM Eastern Daylight Time		05/29/2015 12:22:32 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	110	0	2016	State of North Carolina		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	111	0		29	10	S5660_111_0	1		1	05/27/2015	2016.01	05/27/2015 04:20:22 PM Eastern Daylight Time		05/29/2015 11:57:24 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	111	0	2016	State of South Carolina		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	112	0		29	10	S5660_112_0	1		1	05/27/2015	2016.01	05/27/2015 04:20:40 PM Eastern Daylight Time		05/29/2015 11:57:52 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	112	0	2016	State of Georgia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	113	0		29	10	S5660_113_0	1		1	05/29/2015	2016.01	05/29/2015 12:10:15 PM Eastern Daylight Time		05/29/2015 11:58:22 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	113	0	2016	State of Florida		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	114	0		29	10	S5660_114_0	1		1	05/28/2015	2016.01	05/28/2015 06:02:32 PM Eastern Daylight Time		05/29/2015 11:58:52 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	114	0	2016	States of Alabama and Tennessee		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	115	0		29	10	S5660_115_0	1		1	05/27/2015	2016.01	05/27/2015 04:21:47 PM Eastern Daylight Time		05/29/2015 11:59:20 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	115	0	2016	State of Michigan		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	116	0		29	10	S5660_116_0	1		1	05/27/2015	2016.01	05/27/2015 04:22:09 PM Eastern Daylight Time		05/29/2015 11:59:50 AM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	116	0	2016	State of Ohio		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	117	0		29	10	S5660_117_0	1		1	05/27/2015	2016.01	05/27/2015 04:22:25 PM Eastern Daylight Time		05/29/2015 12:00:22 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	117	0	2016	States of Indiana and Kentucky		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	118	0		29	10	S5660_118_0	1		1	05/27/2015	2016.01	05/27/2015 04:22:43 PM Eastern Daylight Time		05/29/2015 12:00:52 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	118	0	2016	State of Wisconsin		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	119	0		29	10	S5660_119_0	1		1	05/27/2015	2016.01	05/27/2015 04:23:04 PM Eastern Daylight Time		05/29/2015 12:01:20 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	119	0	2016	State of Illinois		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	120	0		29	10	S5660_120_0	1		1	05/27/2015	2016.01	05/27/2015 04:23:27 PM Eastern Daylight Time		05/29/2015 12:01:50 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	120	0	2016	State of Missouri		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	121	0		29	10	S5660_121_0	1		1	05/27/2015	2016.01	05/27/2015 04:24:21 PM Eastern Daylight Time		05/29/2015 12:02:20 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	121	0	2016	State of Arkansas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	122	0		29	10	S5660_122_0	1		1	05/29/2015	2016.01	05/29/2015 12:27:57 PM Eastern Daylight Time		05/29/2015 12:02:50 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	122	0	2016	State of Mississippi		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	123	0		29	10	S5660_123_0	1		1	05/27/2015	2016.01	05/27/2015 04:25:21 PM Eastern Daylight Time		05/29/2015 12:03:20 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	123	0	2016	State of Louisiana		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	124	0		29	10	S5660_124_0	1		1	05/27/2015	2016.01	05/27/2015 04:25:42 PM Eastern Daylight Time		05/29/2015 12:03:50 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	124	0	2016	State of Texas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	125	0		29	10	S5660_125_0	1		1	05/27/2015	2016.01	05/27/2015 04:26:11 PM Eastern Daylight Time		05/29/2015 12:04:20 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	125	0	2016	State of Oklahoma		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	126	0		29	10	S5660_126_0	1		1	05/27/2015	2016.01	05/27/2015 04:26:38 PM Eastern Daylight Time		05/29/2015 12:04:48 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	126	0	2016	State of Kansas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	127	0		29	10	S5660_127_0	1		1	05/27/2015	2016.01	05/27/2015 04:26:58 PM Eastern Daylight Time		05/29/2015 12:05:18 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	127	0	2016	Upper Midwest and Northern Plains		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	128	0		29	10	S5660_128_0	1		1	05/27/2015	2016.01	05/27/2015 04:27:27 PM Eastern Daylight Time		05/29/2015 12:05:46 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	128	0	2016	State of New Mexico		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	129	0		29	10	S5660_129_0	1		1	05/27/2015	2016.01	05/27/2015 04:27:46 PM Eastern Daylight Time		05/29/2015 12:06:16 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	129	0	2016	State of Colorado		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	130	0		29	10	S5660_130_0	1		1	05/27/2015	2016.01	05/27/2015 04:28:04 PM Eastern Daylight Time		05/29/2015 12:06:46 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	130	0	2016	State of Arizona		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	131	0		29	10	S5660_131_0	1		1	05/27/2015	2016.01	05/27/2015 04:28:25 PM Eastern Daylight Time		05/29/2015 12:07:14 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	131	0	2016	State of Nevada		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	132	0		29	10	S5660_132_0	1		1	05/27/2015	2016.01	05/27/2015 04:28:43 PM Eastern Daylight Time		05/29/2015 12:07:44 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	132	0	2016	States of Oregon and Washington		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	133	0		29	10	S5660_133_0	1		1	05/27/2015	2016.01	05/27/2015 04:29:53 PM Eastern Daylight Time		05/29/2015 12:08:14 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	133	0	2016	States of Idaho and Utah		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	134	0		29	10	S5660_134_0	1		1	05/27/2015	2016.01	05/27/2015 04:30:13 PM Eastern Daylight Time		05/29/2015 12:08:42 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	134	0	2016	State of California		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	135	0		29	10	S5660_135_0	1		1	05/27/2015	2016.01	05/27/2015 04:30:31 PM Eastern Daylight Time		05/29/2015 12:09:12 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	135	0	2016	State of Hawaii		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	136	0		29	10	S5660_136_0	1		1	05/27/2015	2016.01	05/27/2015 04:30:52 PM Eastern Daylight Time		05/29/2015 12:09:42 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	136	0	2016	State of Alaska		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	137	0		29	10	S5660_137_0	1		1	05/27/2015	2016.01	05/27/2015 04:31:17 PM Eastern Daylight Time		05/29/2015 12:10:12 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	137	0	2016	Puerto Rico		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	172	0		29	10	S5660_172_0	2		1	05/29/2015	2016.01	05/29/2015 03:46:13 PM Eastern Daylight Time		05/30/2015 11:45:50 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	172	0	2016	Northern New England		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	176	0		29	10	S5660_176_0	1		1	05/27/2015	2016.01	05/27/2015 02:13:39 PM Eastern Daylight Time		05/30/2015 11:46:20 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	176	0	2016	States of Pennsylvania and West Virginia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	180	0		29	10	S5660_180_0	1		1	05/27/2015	2016.01	05/27/2015 02:14:00 PM Eastern Daylight Time		05/30/2015 11:46:48 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	180	0	2016	State of Georgia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	181	0		29	10	S5660_181_0	1		1	05/27/2015	2016.01	05/27/2015 02:14:19 PM Eastern Daylight Time		05/30/2015 11:47:18 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	181	0	2016	State of Florida		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	182	0		29	10	S5660_182_0	1		1	05/29/2015	2016.01	05/29/2015 11:04:42 AM Eastern Daylight Time		05/30/2015 11:47:48 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	182	0	2016	States of Alabama and Tennessee		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	183	0		29	10	S5660_183_0	1		1	05/27/2015	2016.01	05/27/2015 02:15:03 PM Eastern Daylight Time		05/30/2015 11:48:18 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	183	0	2016	State of Michigan		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	184	0		29	10	S5660_184_0	1		1	05/27/2015	2016.01	05/27/2015 02:15:54 PM Eastern Daylight Time		05/30/2015 11:48:48 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	184	0	2016	State of Ohio		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	185	0		29	10	S5660_185_0	1		1	05/27/2015	2016.01	05/27/2015 02:16:09 PM Eastern Daylight Time		05/30/2015 11:49:18 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	185	0	2016	States of Indiana and Kentucky		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	186	0		29	10	S5660_186_0	1		1	05/27/2015	2016.01	05/27/2015 02:16:29 PM Eastern Daylight Time		05/30/2015 11:49:48 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	186	0	2016	State of Wisconsin		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	187	0		29	10	S5660_187_0	1		1	05/27/2015	2016.01	05/27/2015 02:17:07 PM Eastern Daylight Time		05/30/2015 11:50:18 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	187	0	2016	State of Illinois		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	190	0		29	10	S5660_190_0	1		1	05/27/2015	2016.01	05/27/2015 02:17:21 PM Eastern Daylight Time		05/30/2015 11:50:48 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	190	0	2016	State of Mississippi		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	192	0		29	10	S5660_192_0	1		1	05/27/2015	2016.01	05/27/2015 02:17:39 PM Eastern Daylight Time		05/30/2015 11:51:18 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	192	0	2016	State of Texas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	194	0		29	10	S5660_194_0	1		1	05/27/2015	2016.01	05/27/2015 02:17:53 PM Eastern Daylight Time		05/30/2015 11:51:48 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	194	0	2016	State of Kansas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	195	0		29	10	S5660_195_0	1		1	05/27/2015	2016.01	05/27/2015 02:18:08 PM Eastern Daylight Time		05/30/2015 11:52:18 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	195	0	2016	Upper Midwest and Northern Plains		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	196	0		29	10	S5660_196_0	1		1	05/27/2015	2016.01	05/27/2015 02:18:34 PM Eastern Daylight Time		05/30/2015 11:52:48 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	196	0	2016	State of New Mexico		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	197	0		29	10	S5660_197_0	1		1	05/27/2015	2016.01	05/27/2015 02:18:49 PM Eastern Daylight Time		05/30/2015 11:53:18 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	197	0	2016	State of Colorado		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	198	0		29	10	S5660_198_0	1		1	05/27/2015	2016.01	05/27/2015 02:19:03 PM Eastern Daylight Time		05/30/2015 11:53:48 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	198	0	2016	State of Arizona		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	199	0		29	10	S5660_199_0	1		1	05/27/2015	2016.01	05/27/2015 02:19:20 PM Eastern Daylight Time		05/30/2015 11:54:18 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	199	0	2016	State of Nevada		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	202	0		29	10	S5660_202_0	1		1	05/27/2015	2016.01	05/27/2015 02:19:33 PM Eastern Daylight Time		05/30/2015 11:54:46 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	202	0	2016	State of California		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	203	0		29	10	S5660_203_0	1		1	05/27/2015	2016.01	05/27/2015 02:19:56 PM Eastern Daylight Time		05/30/2015 11:55:16 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	203	0	2016	State of Hawaii		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	204	0		29	10	S5660_204_0	1		1	05/27/2015	2016.01	05/27/2015 02:20:10 PM Eastern Daylight Time		05/30/2015 11:55:46 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	204	0	2016	State of Alaska		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	205	0		29	10	S5660_205_0	1		1	05/27/2015	2016.01	05/27/2015 02:20:24 PM Eastern Daylight Time		05/30/2015 11:56:14 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	205	0	2016	Puerto Rico		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	206	0		29	10	S5660_206_0	1		1	05/27/2015	2016.01	05/27/2015 02:20:40 PM Eastern Daylight Time		05/30/2015 11:56:44 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	206	0	2016	Central New England		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	207	0		29	10	S5660_207_0	1		1	05/29/2015	2016.01	05/29/2015 02:47:49 PM Eastern Daylight Time		05/30/2015 11:57:14 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	207	0	2016	State of New Jersey		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	208	0		29	10	S5660_208_0	1		1	05/27/2015	2016.01	05/27/2015 02:21:08 PM Eastern Daylight Time		05/30/2015 11:57:44 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	208	0	2016	Mid-Atlantic		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	209	0		29	10	S5660_209_0	1		1	05/27/2015	2016.01	05/27/2015 02:21:30 PM Eastern Daylight Time		05/30/2015 11:58:12 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	209	0	2016	State of North Carolina		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	210	0		29	10	S5660_210_0	1		1	05/27/2015	2016.01	05/27/2015 02:21:53 PM Eastern Daylight Time		05/30/2015 11:58:42 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	210	0	2016	State of South Carolina		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	211	0		29	10	S5660_211_0	1		1	05/27/2015	2016.01	05/27/2015 02:22:09 PM Eastern Daylight Time		05/30/2015 11:59:12 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	211	0	2016	State of Missouri		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	212	0		29	10	S5660_212_0	1		1	05/27/2015	2016.01	05/27/2015 02:22:30 PM Eastern Daylight Time		05/30/2015 11:59:40 AM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	212	0	2016	State of Arkansas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	213	0		29	10	S5660_213_0	1		1	05/27/2015	2016.01	05/27/2015 02:22:43 PM Eastern Daylight Time		05/30/2015 12:00:10 PM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	213	0	2016	State of Louisiana		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	214	0		29	10	S5660_214_0	1		1	05/27/2015	2016.01	05/27/2015 02:22:57 PM Eastern Daylight Time		05/30/2015 12:00:40 PM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	214	0	2016	State of Oklahoma		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	215	0		29	10	S5660_215_0	1		1	05/30/2015	2016.01	05/30/2015 01:52:03 PM Eastern Daylight Time		05/30/2015 12:01:08 PM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	215	0	2016	States of Oregon and Washington		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	216	0		29	10	S5660_216_0	1		1	05/29/2015	2016.01	05/29/2015 05:54:47 PM Eastern Daylight Time		05/30/2015 12:01:38 PM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	216	0	2016	States of Idaho and Utah		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	217	0		29	10	S5660_217_0	1		1	05/27/2015	2016.01	05/27/2015 02:23:58 PM Eastern Daylight Time		05/30/2015 12:02:08 PM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	217	0	2016	State of Virginia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	801	0		29	10	S5660_801_0	2		1	05/30/2015	2016.01	05/30/2015 05:30:49 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	801	0	2016	National - High Performance 5 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	802	0		29	10	S5660_802_0	2		1	05/30/2015	2016.01	05/30/2015 05:30:58 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	802	0	2016	National - National 4 Tier Preferred		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	803	0		29	10	S5660_803_0	2		1	05/30/2015	2016.01	05/30/2015 05:31:05 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	803	0	2016	National -  Premier Performance 4 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	804	0		29	10	S5660_804_0	2		1	05/30/2015	2016.01	05/30/2015 05:31:12 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	804	0	2016	National - High Performance 5 Tier - Non Cal Year		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	806	0		29	10	S5660_806_0	2		1	05/30/2015	2016.01	05/30/2015 05:31:19 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	806	0	2016	National - URMBT 4 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	807	0		29	10	S5660_807_0	2		1	05/30/2015	2016.01	05/30/2015 05:31:25 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	807	0	2016	National - 5 Tier National Preferred		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	809	0		29	10	S5660_809_0	2		1	05/30/2015	2016.01	05/30/2015 05:31:31 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	809	0	2016	National - 5 Tier Premier Performance		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	810	0		29	10	S5660_810_0	2		1	05/30/2015	2016.01	05/30/2015 05:31:38 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	810	0	2016	National - 4 Tier High Performance		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	811	0		29	10	S5660_811_0	2		1	05/30/2015	2016.01	05/30/2015 05:31:45 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	811	0	2016	ESI High Performance 1Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5660	812	0		29	10	S5660_812_0	2		1	05/30/2015	2016.01	05/30/2015 05:31:51 PM Eastern Daylight Time					05/30/2015 05:47:33 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	812	0	2016	ESI Medicare Premier Access 5Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5715	001	0		29	10	S5715_001_0	2		1	05/28/2015	2016.01	05/28/2015 04:36:03 PM Central Daylight Time		07/20/2015 10:56:57 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageil.com	Blue Cross MedicareRx Value (PDP)	10	29					S5715	001	0	2016	State of Illinois		2					2								www.bluecoverageil.com	www.bluecoverageil.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	002	0		29	10	S5715_002_0	2		1	05/28/2015	2016.01	05/28/2015 04:36:37 PM Central Daylight Time		07/20/2015 10:57:34 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageil.com	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	002	0	2016	State of Illinois		2					2								www.bluecoverageil.com	www.bluecoverageil.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	003	0		29	10	S5715_003_0	2		1	05/28/2015	2016.01	05/28/2015 04:36:55 PM Central Daylight Time		07/20/2015 10:58:12 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragenm.com	Blue Cross MedicareRx Value (PDP)	10	29					S5715	003	0	2016	State of New Mexico		2					2								www.bluecoveragenm.com	www.bluecoveragenm.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	004	0		29	10	S5715_004_0	2		1	05/20/2015	2016.01	05/20/2015 06:05:14 PM Central Daylight Time		07/20/2015 10:58:51 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragenm.com	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	004	0	2016	State of New Mexico		2					2								www.bluecoveragenm.com	www.bluecoveragenm.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	005	0		29	10	S5715_005_0	2		1	05/20/2015	2016.01	05/20/2015 06:08:04 PM Central Daylight Time		07/20/2015 10:59:22 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragetx.com	Blue Cross MedicareRx Value (PDP)	10	29					S5715	005	0	2016	State of Texas		2					2								www.bluecoveragetx.com	www.bluecoveragetx.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	006	0		29	10	S5715_006_0	2		1	05/20/2015	2016.01	05/20/2015 06:09:07 PM Central Daylight Time		07/20/2015 10:59:52 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragetx.com	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	006	0	2016	State of Texas		2					2								www.bluecoveragetx.com	www.bluecoveragetx.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	010	0		29	10	S5715_010_0	2		1	05/20/2015	2016.01	05/20/2015 06:10:47 PM Central Daylight Time		07/20/2015 11:00:24 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageok.com	Blue Cross MedicareRx Value (PDP)	10	29					S5715	010	0	2016	State of Oklahoma		2					2								www.bluecoverageok.com	www.bluecoverageok.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	011	0		29	10	S5715_011_0	2		1	05/20/2015	2016.01	05/20/2015 06:12:22 PM Central Daylight Time		07/20/2015 11:00:58 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageok.com	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	011	0	2016	State of Oklahoma		2					2								www.bluecoverageok.com	www.bluecoverageok.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	012	0		29	10	S5715_012_0	2		1	05/20/2015	2016.01	05/20/2015 06:13:11 PM Central Daylight Time		07/20/2015 11:01:34 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageil.com	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	012	0	2016	State of Illinois		2					2								www.bluecoverageil.com	www.bluecoverageil.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	013	0		29	10	S5715_013_0	2		1	05/20/2015	2016.01	05/20/2015 06:13:42 PM Central Daylight Time		07/20/2015 11:02:21 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragenm.com	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	013	0	2016	State of New Mexico		2					2								www.bluecoveragenm.com	www.bluecoveragenm.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	014	0		29	10	S5715_014_0	2		1	05/28/2015	2016.01	05/28/2015 04:37:23 PM Central Daylight Time		07/20/2015 11:03:09 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragetx.com	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	014	0	2016	State of Texas		2					2								www.bluecoveragetx.com	www.bluecoveragetx.com									(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	05/20/2015	2016.01	05/20/2015 06:16:11 PM Central Daylight Time		07/20/2015 11:03:47 AM Central Daylight Time			07/20/2015 04:11:33 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageok.com	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	015	0	2016	State of Oklahoma		2					2								www.bluecoverageok.com	www.bluecoverageok.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	801	0		29	10	S5715_801_0	1		1	04/16/2015	2016.01	04/16/2015 12:09:47 PM Central Daylight Time					05/29/2015 07:54:04 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageil.com	Blue Cross MedicareRx (PDP)	10	29					S5715	801	0	2016	State of Illinois		1					2								www.bluecoverageil.com	www.bluecoverageil.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	802	0		29	10	S5715_802_0	1		1	04/16/2015	2016.01	04/16/2015 12:09:52 PM Central Daylight Time					05/29/2015 07:54:04 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragenm.com	Blue Cross MedicareRx (PDP)	10	29					S5715	802	0	2016	State of New Mexico		1					2								www.bluecoveragenm.com	www.bluecoveragenm.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	803	0		29	10	S5715_803_0	1		1	04/16/2015	2016.01	04/16/2015 12:09:57 PM Central Daylight Time					05/29/2015 07:54:04 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragetx.com	Blue Cross MedicareRx (PDP)	10	29					S5715	803	0	2016	State of Texas		1					2								www.bluecoveragetx.com	www.bluecoveragetx.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	807	0		29	10	S5715_807_0	1		1	04/16/2015	2016.01	04/16/2015 12:10:01 PM Central Daylight Time					05/29/2015 07:54:04 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageok.com	Blue Cross MedicareRx (PDP)	10	29					S5715	807	0	2016	State of Oklahoma		1					2								www.bluecoverageok.com	www.bluecoverageok.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	809	0		29	10	S5715_809_0	1		1	04/16/2015	2016.01	04/16/2015 12:10:04 PM Central Daylight Time					05/29/2015 07:54:04 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageok.com	Blue Cross MedicareRx (PDP)	10	29					S5715	809	0	2016	State of Oklahoma		1					2								www.bluecoverageok.com	www.bluecoverageok.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	811	0		29	10	S5715_811_0	1		1	04/16/2015	2016.01	04/16/2015 12:10:08 PM Central Daylight Time					05/29/2015 07:54:04 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoverageil.com	Blue Cross MedicareRx (PDP)	10	29					S5715	811	0	2016	State of Illinois		1					2								www.bluecoverageil.com	www.bluecoverageil.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	813	0		29	10	S5715_813_0	1		1	04/16/2015	2016.01	04/16/2015 12:10:14 PM Central Daylight Time					05/29/2015 07:54:04 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragenm.com	Blue Cross MedicareRx (PDP)	10	29					S5715	813	0	2016	State of New Mexico		1					2								www.bluecoveragenm.com	www.bluecoveragenm.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	815	0		29	10	S5715_815_0	1		1	04/16/2015	2016.01	04/16/2015 12:10:18 PM Central Daylight Time					05/29/2015 07:54:04 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.bluecoveragetx.com	Blue Cross MedicareRx (PDP)	10	29					S5715	815	0	2016	State of Texas		1					2								www.bluecoveragetx.com	www.bluecoveragetx.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	4		1	07/14/2015	2016.01	07/14/2015 10:19:18 AM Eastern Daylight Time		07/10/2015 01:36:33 PM Eastern Daylight Time			07/14/2015 10:33:26 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	www.partdkansas.com/shop	Blue MedicareRx Value (PDP)	10	29					S5726	013	0	2016	Kansas		2					2								www.PartDKansas.com/shop	www.PartDKansas.com/shop									(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-																
S5726	014	0		29	10	S5726_014_0	4		1	07/14/2015	2016.01	07/14/2015 10:19:29 AM Eastern Daylight Time		07/10/2015 01:37:17 PM Eastern Daylight Time			07/14/2015 10:33:26 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	www.partdkansas.com/shop	Blue MedicareRx Plus (PDP)	10	29					S5726	014	0	2016	Kansas		2					2								www.PartDKansas.com/shop	www.PartDKansas.com/shop									(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-																
S5726	015	0		29	10	S5726_015_0	4		1	07/14/2015	2016.01	07/14/2015 10:19:41 AM Eastern Daylight Time		07/10/2015 01:37:54 PM Eastern Daylight Time			07/14/2015 10:33:26 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	www.partdkansas.com/shop	Blue MedicareRx Premier (PDP)	10	29					S5726	015	0	2016	Kansas		2					2								www.PartDKansas.com/shop	www.PartDKansas.com/shop									(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-																
S5726	805	0		29	10	S5726_805_0	1		1	05/20/2015	2016.01	05/20/2015 03:27:00 PM Eastern Daylight Time					05/29/2015 03:02:52 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	www.PartDKansas.com/shop	Blue MedicareRx (PDP)	10	29					S5726	805	0	2016	Kansas		1					2								www.PartDKansas.com/shop	www.PartDKansas.com/shop									(866)830-0174		(866)830-0174		(866)830-0296		(866)830-0296										(711)-		(711)-		(711)-		(711)-																
S5743	001	0		29	10	S5743_001_0	2		1	05/27/2015	2016.01	05/27/2015 09:56:49 AM Central Daylight Time		05/27/2015 11:31:32 PM Central Daylight Time			05/29/2015 03:58:00 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	2016	States of IA, MN, MT, NE, ND, SD, WY		2					2								www.YourMedicareSolutions.com	www.YourMedicareSolutions.com									(888)832-0075		(888)832-0075		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-																
S5743	004	0		29	10	S5743_004_0	2		1	05/28/2015	2016.01	05/28/2015 03:39:31 PM Central Daylight Time		05/27/2015 08:43:44 PM Central Daylight Time			05/29/2015 03:58:00 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	2016	States of IA, MN, MT, NE, ND, SD, WY		2					2								www.YourMedicareSolutions.com	www.YourMedicareSolutions.com									(888)832-0075		(888)832-0075		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-																
S5743	802	0		29	10	S5743_802_0	1		1	05/26/2015	2016.01	05/26/2015 04:38:34 PM Central Daylight Time					05/28/2015 02:15:22 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	2016	Nationwide		1					2								www.YourMedicareSolutions.com	www.YourMedicareSolutions.com									(877)838-3827		(877)838-3827		(866)456-2885		(866)456-2885										(711)-		(711)-		(711)-		(711)-																
S5743	805	0		29	10	S5743_805_0	1		1	05/26/2015	2016.01	05/26/2015 04:38:50 PM Central Daylight Time					05/28/2015 02:15:22 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	Group MedicareBlue Rx Self-funded (PDP) (PDP)	10	29					S5743	805	0	2016	Nationwide		1					2								www.YourMedicareSolutions.com	www.YourMedicareSolutions.com									(877)838-3827		(877)838-3827		(866)456-2885		(866)456-2885										(711)-		(711)-		(711)-		(711)-																
S5753	006	0		29	10	S5753_006_0	1		1	05/28/2015	2016.01	05/28/2015 05:05:55 PM Central Daylight Time		05/28/2015 06:54:25 PM Central Daylight Time			05/28/2015 07:48:21 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS MedicareRx Plan 1 (PDP)	10	29					S5753	006	0	2016	State of Wisconsin		2					2								www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com									(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-																
S5753	007	0		29	10	S5753_007_0	1		1	05/28/2015	2016.01	05/28/2015 05:11:28 PM Central Daylight Time		05/28/2015 06:55:14 PM Central Daylight Time			05/28/2015 07:48:21 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS MedicareRx Plan 2 (PDP)	10	29					S5753	007	0	2016	State of Wisconsin		2					2								www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com									(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-																
S5753	801	0		29	10	S5753_801_0	1		1	04/15/2015	2016.01	04/15/2015 04:53:15 PM Central Daylight Time					05/28/2015 07:48:21 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS Employer Plan - Calendar Year (PDP)	10	29					S5753	801	0	2016	National		1					2								www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com									(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-																
S5753	803	0		29	10	S5753_803_0	1		1	04/15/2015	2016.01	04/15/2015 04:53:33 PM Central Daylight Time					05/28/2015 07:48:21 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS Employer Plan Non-Calendar Year (PDP)	10	29					S5753	803	0	2016	National		1					2								www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com									(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-																
S5755	006	0		29	10	S5755_006_0	4		1	05/31/2015	2016.01	05/31/2015 10:02:23 PM Central Daylight Time		07/07/2015 06:04:27 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	006	0	2016	States of CT, MA, RI and VT		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	007	0		29	10	S5755_007_0	4		1	05/31/2015	2016.01	05/31/2015 10:03:28 PM Central Daylight Time		07/07/2015 06:05:20 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	007	0	2016	State of New Jersey		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	008	0		29	10	S5755_008_0	4		1	05/31/2015	2016.01	05/31/2015 10:04:45 PM Central Daylight Time		07/07/2015 06:18:22 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	008	0	2016	States of Delaware and Maryland plus DC		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	009	0		29	10	S5755_009_0	4		1	05/31/2015	2016.01	05/31/2015 10:06:22 PM Central Daylight Time		07/07/2015 06:07:43 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	009	0	2016	States of Pennsylvania and West Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	010	0		29	10	S5755_010_0	4		1	05/31/2015	2016.01	05/31/2015 10:09:12 PM Central Daylight Time		07/07/2015 06:08:13 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	010	0	2016	State of Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	011	0		29	10	S5755_011_0	4		1	05/31/2015	2016.01	05/31/2015 10:10:20 PM Central Daylight Time		07/07/2015 06:08:44 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	011	0	2016	State of North Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	012	0		29	10	S5755_012_0	4		1	05/31/2015	2016.01	05/31/2015 10:11:24 PM Central Daylight Time		07/07/2015 06:09:02 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	012	0	2016	State of South Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	013	0		29	10	S5755_013_0	4		1	05/31/2015	2016.01	05/31/2015 10:12:33 PM Central Daylight Time		07/07/2015 06:09:20 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	013	0	2016	State of Georgia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	014	0		29	10	S5755_014_0	4		1	05/31/2015	2016.01	05/31/2015 10:16:36 PM Central Daylight Time		07/07/2015 06:09:40 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	014	0	2016	State of Florida		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	015	0		29	10	S5755_015_0	4		1	05/31/2015	2016.01	05/31/2015 11:53:42 PM Central Daylight Time		07/07/2015 06:09:57 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	015	0	2016	States of Alabama and Tennessee		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	016	0		29	10	S5755_016_0	4		1	05/31/2015	2016.01	05/31/2015 10:19:39 PM Central Daylight Time		07/07/2015 06:10:11 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	016	0	2016	State of Michigan		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	017	0		29	10	S5755_017_0	4		1	05/31/2015	2016.01	05/31/2015 10:20:50 PM Central Daylight Time		07/07/2015 06:10:25 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	017	0	2016	State of Ohio		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	018	0		29	10	S5755_018_0	4		1	05/31/2015	2016.01	05/31/2015 10:23:32 PM Central Daylight Time		07/07/2015 06:10:40 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	018	0	2016	States of Indiana and Kentucky		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	020	0		29	10	S5755_020_0	4		1	05/31/2015	2016.01	05/31/2015 11:55:03 PM Central Daylight Time		07/07/2015 06:10:54 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	020	0	2016	State of Illinois		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	021	0		29	10	S5755_021_0	4		1	05/31/2015	2016.01	05/31/2015 10:25:52 PM Central Daylight Time		07/07/2015 06:11:12 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	021	0	2016	State of Missouri		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	022	0		29	10	S5755_022_0	5		1	05/31/2015	2016.01	05/31/2015 04:01:54 PM Central Daylight Time		07/10/2015 02:08:11 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	022	0	2016	State of Arkansas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	023	0		29	10	S5755_023_0	4		1	05/31/2015	2016.01	05/31/2015 10:27:25 PM Central Daylight Time		07/07/2015 06:11:33 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	023	0	2016	State of Mississippi		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	024	0		29	10	S5755_024_0	4		1	05/31/2015	2016.01	05/31/2015 10:28:40 PM Central Daylight Time		07/07/2015 06:11:51 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	024	0	2016	State of Louisiana		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	025	0		29	10	S5755_025_0	4		1	05/31/2015	2016.01	05/31/2015 10:30:10 PM Central Daylight Time		07/07/2015 06:12:08 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	025	0	2016	State of Texas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	026	0		29	10	S5755_026_0	4		1	05/31/2015	2016.01	05/31/2015 10:31:44 PM Central Daylight Time		07/07/2015 06:12:25 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	026	0	2016	State of Oklahoma		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	028	0		29	10	S5755_028_0	4		1	05/31/2015	2016.01	05/31/2015 10:33:02 PM Central Daylight Time		07/07/2015 06:12:40 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	028	0	2016	States of IA, MN, MT, NE, ND, SD and WY		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	029	0		29	10	S5755_029_0	4		1	05/31/2015	2016.01	05/31/2015 10:35:22 PM Central Daylight Time		07/07/2015 06:12:55 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	029	0	2016	State of New Mexico		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	030	0		29	10	S5755_030_0	4		1	07/10/2015	2016.01	07/10/2015 02:10:43 PM Central Daylight Time		07/07/2015 06:13:25 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	030	0	2016	State of Colorado		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	031	0		29	10	S5755_031_0	4		1	05/31/2015	2016.01	05/31/2015 10:37:49 PM Central Daylight Time		07/07/2015 06:13:42 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	031	0	2016	State of Arizona		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	032	0		29	10	S5755_032_0	4		1	05/31/2015	2016.01	05/31/2015 10:39:09 PM Central Daylight Time		07/07/2015 06:13:59 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	032	0	2016	State of Nevada		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	033	0		29	10	S5755_033_0	4		1	05/31/2015	2016.01	05/31/2015 04:29:20 PM Central Daylight Time		07/07/2015 06:14:29 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	033	0	2016	States of Oregon and Washington		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	034	0		29	10	S5755_034_0	4		1	05/31/2015	2016.01	05/31/2015 04:30:34 PM Central Daylight Time		07/07/2015 06:14:43 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	034	0	2016	States of Idaho and Utah		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	035	0		29	10	S5755_035_0	4		1	05/31/2015	2016.01	05/31/2015 10:40:27 PM Central Daylight Time		07/07/2015 06:14:56 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	035	0	2016	State of California		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	038	0		29	10	S5755_038_0	6		1	05/29/2015	2016.01	05/29/2015 11:59:57 PM Central Daylight Time		07/08/2015 11:35:51 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	038	0	2016	State of Hawaii		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	039	0		29	10	S5755_039_0	5		1	05/30/2015	2016.01	05/30/2015 12:01:16 AM Central Daylight Time		07/08/2015 11:37:28 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	039	0	2016	State of Alaska		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	073	0		29	10	S5755_073_0	5		1	05/29/2015	2016.01	05/29/2015 11:07:58 PM Central Daylight Time		07/08/2015 11:37:57 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	073	0	2016	States of Maine and New Hampshire		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	074	0		29	10	S5755_074_0	5		1	05/29/2015	2016.01	05/29/2015 11:09:37 PM Central Daylight Time		07/08/2015 11:38:36 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	074	0	2016	States of CT, MA, RI, and VT		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	075	0		29	10	S5755_075_0	5		1	05/29/2015	2016.01	05/29/2015 11:13:32 PM Central Daylight Time		07/08/2015 11:39:08 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	075	0	2016	State of New Jersey		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	076	0		29	10	S5755_076_0	5		1	05/29/2015	2016.01	05/29/2015 11:15:45 PM Central Daylight Time		07/08/2015 11:39:24 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	076	0	2016	States of Delaware, Maryland and DC		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	077	0		29	10	S5755_077_0	5		1	05/29/2015	2016.01	05/29/2015 11:17:14 PM Central Daylight Time		07/08/2015 11:39:50 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	077	0	2016	States of Pennsylvania and West Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	078	0		29	10	S5755_078_0	5		1	05/29/2015	2016.01	05/29/2015 11:20:54 PM Central Daylight Time		07/08/2015 11:40:20 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	078	0	2016	State of Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	079	0		29	10	S5755_079_0	5		1	05/29/2015	2016.01	05/29/2015 11:23:24 PM Central Daylight Time		07/08/2015 11:40:35 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	079	0	2016	State of North Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	080	0		29	10	S5755_080_0	5		1	05/29/2015	2016.01	05/29/2015 11:25:06 PM Central Daylight Time		07/08/2015 11:40:53 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	080	0	2016	State of South Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	081	0		29	10	S5755_081_0	5		1	05/29/2015	2016.01	05/29/2015 11:26:38 PM Central Daylight Time		07/08/2015 11:42:42 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	081	0	2016	State of Georgia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	082	0		29	10	S5755_082_0	5		1	05/31/2015	2016.01	05/31/2015 05:15:31 PM Central Daylight Time		07/08/2015 11:44:11 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	082	0	2016	State of Florida		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	083	0		29	10	S5755_083_0	5		1	05/29/2015	2016.01	05/29/2015 11:29:23 PM Central Daylight Time		07/08/2015 11:44:35 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	083	0	2016	States of Alabama and Tennessee		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	084	0		29	10	S5755_084_0	5		1	05/29/2015	2016.01	05/29/2015 11:31:12 PM Central Daylight Time		07/08/2015 11:44:56 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	084	0	2016	State of Michigan		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	085	0		29	10	S5755_085_0	5		1	05/29/2015	2016.01	05/29/2015 11:32:49 PM Central Daylight Time		07/08/2015 11:45:18 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	085	0	2016	State of Ohio		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	086	0		29	10	S5755_086_0	5		1	05/29/2015	2016.01	05/29/2015 11:34:15 PM Central Daylight Time		07/08/2015 11:45:37 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	086	0	2016	States of Indiana and Kentucky		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	087	0		29	10	S5755_087_0	5		1	05/29/2015	2016.01	05/29/2015 11:35:46 PM Central Daylight Time		07/08/2015 11:46:43 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	087	0	2016	State of Wisconsin		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	088	0		29	10	S5755_088_0	5		1	05/29/2015	2016.01	05/29/2015 11:37:27 PM Central Daylight Time		07/08/2015 11:47:09 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	088	0	2016	State of Illinois		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	089	0		29	10	S5755_089_0	5		1	05/29/2015	2016.01	05/29/2015 11:38:43 PM Central Daylight Time		07/08/2015 11:47:28 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	089	0	2016	State of Missouri		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	091	0		29	10	S5755_091_0	5		1	05/29/2015	2016.01	05/29/2015 11:41:40 PM Central Daylight Time		07/08/2015 11:47:45 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	091	0	2016	State of Mississippi		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	092	0		29	10	S5755_092_0	5		1	05/29/2015	2016.01	05/29/2015 11:42:43 PM Central Daylight Time		07/08/2015 11:48:07 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	092	0	2016	State of Louisiana		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	093	0		29	10	S5755_093_0	5		1	05/29/2015	2016.01	05/29/2015 11:44:06 PM Central Daylight Time		07/08/2015 11:48:36 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	093	0	2016	State of Texas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	094	0		29	10	S5755_094_0	5		1	05/29/2015	2016.01	05/29/2015 11:45:43 PM Central Daylight Time		07/08/2015 11:48:52 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	094	0	2016	State of Oklahoma		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	095	0		29	10	S5755_095_0	5		1	05/29/2015	2016.01	05/29/2015 11:47:11 PM Central Daylight Time		07/08/2015 11:50:36 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	095	0	2016	State of Kansas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	096	0		29	10	S5755_096_0	5		1	05/29/2015	2016.01	05/29/2015 11:48:54 PM Central Daylight Time		07/08/2015 11:51:43 AM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	096	0	2016	States of IA, MN, MT, NE, ND, SD, and WY		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	097	0		29	10	S5755_097_0	5		1	05/29/2015	2016.01	05/29/2015 11:50:08 PM Central Daylight Time		07/08/2015 12:01:24 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	097	0	2016	State of New Mexico		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	098	0		29	10	S5755_098_0	5		1	05/29/2015	2016.01	05/29/2015 11:51:40 PM Central Daylight Time		07/08/2015 12:01:46 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	098	0	2016	State of Colorado		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	099	0		29	10	S5755_099_0	5		1	05/29/2015	2016.01	05/29/2015 11:53:06 PM Central Daylight Time		07/08/2015 12:02:03 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	099	0	2016	State of Arizona		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	100	0		29	10	S5755_100_0	5		1	05/29/2015	2016.01	05/29/2015 11:54:32 PM Central Daylight Time		07/08/2015 12:06:15 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	100	0	2016	State of Nevada		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	101	0		29	10	S5755_101_0	5		1	05/29/2015	2016.01	05/29/2015 11:56:02 PM Central Daylight Time		07/08/2015 12:06:32 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	101	0	2016	States of Oregon and Washington		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	102	0		29	10	S5755_102_0	5		1	05/29/2015	2016.01	05/29/2015 11:57:20 PM Central Daylight Time		07/08/2015 12:06:49 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	102	0	2016	States of Idaho and Utah		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	103	0		29	10	S5755_103_0	5		1	05/29/2015	2016.01	05/29/2015 11:58:32 PM Central Daylight Time		07/08/2015 12:07:05 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	103	0	2016	State of California		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	107	0		29	10	S5755_107_0	6		1	06/30/2015	2016.01	06/30/2015 09:41:15 AM Central Daylight Time		07/08/2015 08:36:28 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	107	0	2016	States of Maine and New Hampshire		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	108	0		29	10	S5755_108_0	6		1	06/30/2015	2016.01	06/30/2015 09:42:02 AM Central Daylight Time		07/08/2015 08:37:24 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	108	0	2016	States of CT, MA, RI, and VT		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	109	0		29	10	S5755_109_0	6		1	06/30/2015	2016.01	06/30/2015 09:43:28 AM Central Daylight Time		07/08/2015 08:37:40 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	109	0	2016	State of New Jersey		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	110	0		29	10	S5755_110_0	6		1	06/30/2015	2016.01	06/30/2015 09:44:06 AM Central Daylight Time		07/08/2015 08:37:56 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	110	0	2016	States of Delaware, Maryland and DC		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	111	0		29	10	S5755_111_0	6		1	06/30/2015	2016.01	06/30/2015 09:49:26 AM Central Daylight Time		07/08/2015 08:38:13 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	111	0	2016	States of Pennsylvania and West Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	112	0		29	10	S5755_112_0	6		1	06/30/2015	2016.01	06/30/2015 09:50:07 AM Central Daylight Time		07/08/2015 08:38:29 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	112	0	2016	State of Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	113	0		29	10	S5755_113_0	6		1	06/30/2015	2016.01	06/30/2015 09:50:54 AM Central Daylight Time		07/08/2015 08:38:44 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	113	0	2016	State of North Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	114	0		29	10	S5755_114_0	6		1	06/30/2015	2016.01	06/30/2015 09:52:25 AM Central Daylight Time		07/08/2015 08:38:59 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	114	0	2016	State of South Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	115	0		29	10	S5755_115_0	6		1	06/30/2015	2016.01	06/30/2015 09:52:55 AM Central Daylight Time		07/08/2015 08:39:13 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	115	0	2016	State of Georgia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	116	0		29	10	S5755_116_0	6		1	06/30/2015	2016.01	06/30/2015 09:53:25 AM Central Daylight Time		07/08/2015 08:39:28 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	116	0	2016	State of Florida		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	117	0		29	10	S5755_117_0	6		1	06/30/2015	2016.01	06/30/2015 09:53:59 AM Central Daylight Time		07/08/2015 08:39:45 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	117	0	2016	States of Alabama and Tennessee		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	118	0		29	10	S5755_118_0	6		1	06/30/2015	2016.01	06/30/2015 09:55:02 AM Central Daylight Time		07/08/2015 08:40:00 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	118	0	2016	State of Michigan		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	119	0		29	10	S5755_119_0	6		1	06/30/2015	2016.01	06/30/2015 10:12:56 AM Central Daylight Time		07/08/2015 08:40:14 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	119	0	2016	State of Ohio		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	120	0		29	10	S5755_120_0	6		1	06/30/2015	2016.01	06/30/2015 10:13:34 AM Central Daylight Time		07/08/2015 08:40:29 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	120	0	2016	States of Indiana and Kentucky		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	121	0		29	10	S5755_121_0	6		1	06/30/2015	2016.01	06/30/2015 10:14:14 AM Central Daylight Time		07/08/2015 08:40:43 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	121	0	2016	State of Wisconsin		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	122	0		29	10	S5755_122_0	6		1	06/30/2015	2016.01	06/30/2015 10:15:03 AM Central Daylight Time		07/08/2015 08:40:58 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	122	0	2016	State of Illinois		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	123	0		29	10	S5755_123_0	6		1	06/30/2015	2016.01	06/30/2015 10:15:50 AM Central Daylight Time		07/08/2015 08:41:14 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	123	0	2016	State of Missouri		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	124	0		29	10	S5755_124_0	6		1	06/30/2015	2016.01	06/30/2015 10:16:35 AM Central Daylight Time		07/08/2015 08:41:29 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	124	0	2016	State of Mississippi		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	125	0		29	10	S5755_125_0	6		1	06/30/2015	2016.01	06/30/2015 10:17:24 AM Central Daylight Time		07/08/2015 08:41:44 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	125	0	2016	State of Louisiana		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	126	0		29	10	S5755_126_0	6		1	06/30/2015	2016.01	06/30/2015 10:18:12 AM Central Daylight Time		07/08/2015 08:41:59 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	126	0	2016	State of Texas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	127	0		29	10	S5755_127_0	6		1	06/30/2015	2016.01	06/30/2015 10:19:22 AM Central Daylight Time		07/08/2015 08:42:14 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	127	0	2016	State of Oklahoma		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	128	0		29	10	S5755_128_0	6		1	06/30/2015	2016.01	06/30/2015 10:20:13 AM Central Daylight Time		07/08/2015 08:42:31 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	128	0	2016	State of Kansas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	129	0		29	10	S5755_129_0	6		1	06/30/2015	2016.01	06/30/2015 10:20:53 AM Central Daylight Time		07/08/2015 08:42:46 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	129	0	2016	States of IA, MN, MT, NE, ND, SD, and WY		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	130	0		29	10	S5755_130_0	6		1	06/30/2015	2016.01	06/30/2015 10:21:34 AM Central Daylight Time		07/08/2015 08:43:00 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	130	0	2016	State of New Mexico		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	131	0		29	10	S5755_131_0	6		1	06/30/2015	2016.01	06/30/2015 10:22:32 AM Central Daylight Time		07/08/2015 08:43:19 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	131	0	2016	State of Arizona		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	132	0		29	10	S5755_132_0	6		1	06/30/2015	2016.01	06/30/2015 10:23:13 AM Central Daylight Time		07/08/2015 08:43:33 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	132	0	2016	State of Nevada		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	133	0		29	10	S5755_133_0	6		1	06/30/2015	2016.01	06/30/2015 10:32:37 AM Central Daylight Time		07/08/2015 08:43:48 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	133	0	2016	State of California		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	134	0		29	10	S5755_134_0	6		1	06/30/2015	2016.01	06/30/2015 10:33:45 AM Central Daylight Time		07/08/2015 08:44:02 PM Central Daylight Time			07/10/2015 02:19:22 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	134	0	2016	State of Hawaii		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	801	0		29	10	S5755_801_0	4		1	04/21/2015	2016.01	04/21/2015 05:03:56 PM Central Daylight Time					06/01/2015 06:41:31 AM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American Employer Calendar Plan (PDP)	10	29					S5755	801	0	2016	National		1					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4199		(866)524-4199		(866)524-4199		(866)524-4199										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	802	0		29	10	S5755_802_0	4		1	04/21/2015	2016.01	04/21/2015 05:04:01 PM Central Daylight Time					06/01/2015 06:41:31 AM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American Employer Non-Cal Drug Plan (PDP)	10	29					S5755	802	0	2016	National		1					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4199		(866)524-4199		(866)524-4199		(866)524-4199										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	805	0		29	10	S5755_805_0	4		1	04/21/2015	2016.01	04/21/2015 05:04:04 PM Central Daylight Time					06/01/2015 06:41:31 AM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	UA EGWP- Calendar Plan 2nd Formulary Opt. (PDP)	10	29					S5755	805	0	2016	National		1					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4199		(866)524-4199		(866)524-4199		(866)524-4199										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5755	806	0		29	10	S5755_806_0	4		1	04/21/2015	2016.01	04/21/2015 05:04:08 PM Central Daylight Time					06/01/2015 06:41:31 AM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	UA EGWP- Non-Calendar Plan 2nd Formulary Opt. (PDP)	10	29					S5755	806	0	2016	National		1					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4199		(866)524-4199		(866)524-4199		(866)524-4199										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170																
S5768	125	0		29	10	S5768_125_0	1		1	05/22/2015	2016.01	05/22/2015 05:14:09 PM Eastern Daylight Time		05/27/2015 05:27:45 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	125	0	2016	Northern New England (NH, ME)		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	126	0		29	10	S5768_126_0	1		1	05/24/2015	2016.01	05/24/2015 09:52:48 AM Eastern Daylight Time		05/27/2015 05:28:03 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	126	0	2016	Central New England  (CT,RI, MA,VT)		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	127	0		29	10	S5768_127_0	1		1	05/22/2015	2016.01	05/22/2015 04:45:01 PM Eastern Daylight Time		05/27/2015 05:28:22 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	127	0	2016	New Jersey		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	128	0		29	10	S5768_128_0	1		1	05/22/2015	2016.01	05/22/2015 04:46:16 PM Eastern Daylight Time		05/27/2015 05:28:40 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	128	0	2016	Mid-Atlantic (DE,DC,MD)		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	129	0		29	10	S5768_129_0	1		1	05/22/2015	2016.01	05/22/2015 04:47:14 PM Eastern Daylight Time		05/27/2015 05:28:58 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	129	0	2016	Pennsylvania, West Virginia		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	130	0		29	10	S5768_130_0	1		1	05/22/2015	2016.01	05/22/2015 04:47:48 PM Eastern Daylight Time		05/27/2015 05:29:16 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	130	0	2016	Virginia		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	131	0		29	10	S5768_131_0	1		1	05/22/2015	2016.01	05/22/2015 04:48:45 PM Eastern Daylight Time		05/27/2015 05:29:35 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	131	0	2016	North Carolina		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	132	0		29	10	S5768_132_0	1		1	05/22/2015	2016.01	05/22/2015 04:50:04 PM Eastern Daylight Time		05/27/2015 05:29:53 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	132	0	2016	South Carolina		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	133	0		29	10	S5768_133_0	1		1	05/22/2015	2016.01	05/22/2015 04:51:01 PM Eastern Daylight Time		05/27/2015 05:30:11 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	133	0	2016	Georgia		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	134	0		29	10	S5768_134_0	1		1	05/22/2015	2016.01	05/22/2015 04:51:41 PM Eastern Daylight Time		05/27/2015 05:30:30 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	134	0	2016	Florida		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	135	0		29	10	S5768_135_0	1		1	05/22/2015	2016.01	05/22/2015 04:52:30 PM Eastern Daylight Time		05/27/2015 05:30:48 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	135	0	2016	Alabama, Tennessee		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	136	0		29	10	S5768_136_0	1		1	05/22/2015	2016.01	05/22/2015 04:54:02 PM Eastern Daylight Time		05/27/2015 05:31:07 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	136	0	2016	Michigan		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	137	0		29	10	S5768_137_0	1		1	05/22/2015	2016.01	05/22/2015 04:54:52 PM Eastern Daylight Time		05/27/2015 05:31:25 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	137	0	2016	Ohio		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	138	0		29	10	S5768_138_0	1		1	05/22/2015	2016.01	05/22/2015 04:55:32 PM Eastern Daylight Time		05/27/2015 05:31:43 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	138	0	2016	Indiana, Kentucky		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	139	0		29	10	S5768_139_0	1		1	05/22/2015	2016.01	05/22/2015 04:56:38 PM Eastern Daylight Time		05/27/2015 05:32:01 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	139	0	2016	Wisconsin		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	140	0		29	10	S5768_140_0	1		1	05/22/2015	2016.01	05/22/2015 04:57:49 PM Eastern Daylight Time		05/27/2015 05:32:19 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	140	0	2016	Illinois		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	141	0		29	10	S5768_141_0	1		1	05/22/2015	2016.01	05/22/2015 04:58:28 PM Eastern Daylight Time		05/27/2015 05:32:37 PM Eastern Daylight Time			05/28/2015 06:44:05 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	141	0	2016	Missouri		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	142	0		29	10	S5768_142_0	1		1	05/22/2015	2016.01	05/22/2015 04:59:35 PM Eastern Daylight Time		05/27/2015 05:32:55 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	142	0	2016	Arkansas		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	143	0		29	10	S5768_143_0	1		1	05/22/2015	2016.01	05/22/2015 05:01:26 PM Eastern Daylight Time		05/27/2015 05:33:13 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	143	0	2016	Mississippi		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	144	0		29	10	S5768_144_0	1		1	05/22/2015	2016.01	05/22/2015 05:02:23 PM Eastern Daylight Time		05/27/2015 05:33:31 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	144	0	2016	Louisiana		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	145	0		29	10	S5768_145_0	1		1	05/22/2015	2016.01	05/22/2015 05:03:08 PM Eastern Daylight Time		05/27/2015 05:33:49 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	http://www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	145	0	2016	Texas		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	146	0		29	10	S5768_146_0	1		1	05/22/2015	2016.01	05/22/2015 05:03:55 PM Eastern Daylight Time		05/27/2015 05:34:07 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	146	0	2016	Oklahoma		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	147	0		29	10	S5768_147_0	1		1	05/22/2015	2016.01	05/22/2015 05:04:35 PM Eastern Daylight Time		05/27/2015 05:34:25 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	147	0	2016	Kansas		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	148	0		29	10	S5768_148_0	1		1	05/22/2015	2016.01	05/22/2015 05:05:24 PM Eastern Daylight Time		05/27/2015 05:34:43 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	148	0	2016	Upper MW and N Plains (IA,MN,NE,SD,ND,WY,MT)		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	149	0		29	10	S5768_149_0	1		1	05/22/2015	2016.01	05/22/2015 05:06:12 PM Eastern Daylight Time		05/27/2015 05:35:00 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	149	0	2016	New Mexico		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	150	0		29	10	S5768_150_0	1		1	05/21/2015	2016.01	05/21/2015 10:14:30 AM Eastern Daylight Time		05/27/2015 05:35:18 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	150	0	2016	Colorado		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	151	0		29	10	S5768_151_0	1		1	05/22/2015	2016.01	05/22/2015 05:07:07 PM Eastern Daylight Time		05/27/2015 05:35:36 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	151	0	2016	Arizona		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	152	0		29	10	S5768_152_0	1		1	05/22/2015	2016.01	05/22/2015 05:08:08 PM Eastern Daylight Time		05/27/2015 05:35:54 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	152	0	2016	Nevada		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	153	0		29	10	S5768_153_0	1		1	05/22/2015	2016.01	05/22/2015 05:09:20 PM Eastern Daylight Time		05/27/2015 05:36:12 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	153	0	2016	Oregon, Washington		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	154	0		29	10	S5768_154_0	1		1	05/22/2015	2016.01	05/22/2015 05:10:16 PM Eastern Daylight Time		05/27/2015 05:36:30 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	154	0	2016	Idaho, Utah		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	155	0		29	10	S5768_155_0	1		1	05/22/2015	2016.01	05/22/2015 05:11:01 PM Eastern Daylight Time		05/27/2015 05:36:47 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	155	0	2016	California		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	164	0		29	10	S5768_164_0	2		1	05/31/2015	2016.01	05/31/2015 05:40:30 PM Eastern Daylight Time		05/27/2015 05:37:05 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	164	0	2016	Mid-Atlantic (DE,DC,MD)		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	165	0		29	10	S5768_165_0	2		1	05/31/2015	2016.01	05/31/2015 05:41:46 PM Eastern Daylight Time		05/27/2015 05:37:23 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	165	0	2016	Pennsylvania, West Virginia		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	166	0		29	10	S5768_166_0	2		1	05/31/2015	2016.01	05/31/2015 08:12:31 PM Eastern Daylight Time		05/27/2015 05:37:41 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	166	0	2016	Virginia		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	167	0		29	10	S5768_167_0	2		1	05/31/2015	2016.01	05/31/2015 05:44:22 PM Eastern Daylight Time		05/27/2015 05:37:59 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	167	0	2016	North Carolina		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	168	0		29	10	S5768_168_0	2		1	05/31/2015	2016.01	05/31/2015 05:45:26 PM Eastern Daylight Time		05/27/2015 05:38:17 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	168	0	2016	South Carolina		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	169	0		29	10	S5768_169_0	2		1	05/31/2015	2016.01	05/31/2015 05:46:32 PM Eastern Daylight Time		05/27/2015 05:38:35 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	169	0	2016	Georgia		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	170	0		29	10	S5768_170_0	2		1	05/31/2015	2016.01	05/31/2015 05:47:35 PM Eastern Daylight Time		05/27/2015 05:38:53 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	170	0	2016	Alabama, Tennessee		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	171	0		29	10	S5768_171_0	2		1	05/31/2015	2016.01	05/31/2015 05:48:58 PM Eastern Daylight Time		05/27/2015 05:39:11 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	171	0	2016	Michigan		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	172	0		29	10	S5768_172_0	2		1	05/31/2015	2016.01	05/31/2015 05:50:15 PM Eastern Daylight Time		05/27/2015 05:39:29 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	172	0	2016	Ohio		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	173	0		29	10	S5768_173_0	2		1	05/31/2015	2016.01	05/31/2015 05:51:15 PM Eastern Daylight Time		05/27/2015 05:39:47 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	173	0	2016	Wisconsin		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	174	0		29	10	S5768_174_0	2		1	05/31/2015	2016.01	05/31/2015 06:00:09 PM Eastern Daylight Time		05/27/2015 05:40:05 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	174	0	2016	Illinois		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	175	0		29	10	S5768_175_0	2		1	05/31/2015	2016.01	05/31/2015 06:05:19 PM Eastern Daylight Time		05/27/2015 05:40:23 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	175	0	2016	Missouri		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	176	0		29	10	S5768_176_0	2		1	05/31/2015	2016.01	05/31/2015 06:10:34 PM Eastern Daylight Time		05/27/2015 05:40:41 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	176	0	2016	Arkansas		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	177	0		29	10	S5768_177_0	2		1	05/31/2015	2016.01	05/31/2015 08:13:29 PM Eastern Daylight Time		05/27/2015 05:41:00 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	177	0	2016	Mississippi		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	178	0		29	10	S5768_178_0	2		1	05/31/2015	2016.01	05/31/2015 06:13:58 PM Eastern Daylight Time		05/27/2015 05:41:18 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	178	0	2016	Louisiana		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	179	0		29	10	S5768_179_0	2		1	05/31/2015	2016.01	05/31/2015 06:20:19 PM Eastern Daylight Time		05/27/2015 05:41:36 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	179	0	2016	Texas		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	180	0		29	10	S5768_180_0	2		1	05/31/2015	2016.01	05/31/2015 06:21:06 PM Eastern Daylight Time		05/27/2015 05:41:54 PM Eastern Daylight Time			05/31/2015 08:44:41 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	180	0	2016	Oklahoma		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	181	0		29	10	S5768_181_0	2		1	05/31/2015	2016.01	05/31/2015 06:21:48 PM Eastern Daylight Time		05/27/2015 05:42:12 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	181	0	2016	Kansas		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	182	0		29	10	S5768_182_0	2		1	05/31/2015	2016.01	05/31/2015 06:22:37 PM Eastern Daylight Time		05/27/2015 05:42:30 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	182	0	2016	Colorado		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	183	0		29	10	S5768_183_0	2		1	05/31/2015	2016.01	05/31/2015 06:24:07 PM Eastern Daylight Time		05/27/2015 05:42:48 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	183	0	2016	Arizona		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	184	0		29	10	S5768_184_0	2		1	05/31/2015	2016.01	05/31/2015 06:24:55 PM Eastern Daylight Time		05/27/2015 05:43:06 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	184	0	2016	Nevada		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	185	0		29	10	S5768_185_0	2		1	05/31/2015	2016.01	05/31/2015 06:26:15 PM Eastern Daylight Time		05/27/2015 05:43:24 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	185	0	2016	Northern New England (NH, ME)		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	186	0		29	10	S5768_186_0	2		1	05/31/2015	2016.01	05/31/2015 06:27:07 PM Eastern Daylight Time		05/27/2015 05:43:43 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	186	0	2016	Central New England  (CT,RI, MA,VT)		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	187	0		29	10	S5768_187_0	2		1	05/31/2015	2016.01	05/31/2015 06:28:04 PM Eastern Daylight Time		05/27/2015 05:44:01 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	187	0	2016	New Jersey		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	188	0		29	10	S5768_188_0	2		1	05/31/2015	2016.01	05/31/2015 06:29:16 PM Eastern Daylight Time		05/27/2015 05:44:19 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	188	0	2016	Florida		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	189	0		29	10	S5768_189_0	2		1	05/31/2015	2016.01	05/31/2015 06:30:20 PM Eastern Daylight Time		05/27/2015 05:44:37 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	189	0	2016	Indiana, Kentucky		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	190	0		29	10	S5768_190_0	2		1	05/31/2015	2016.01	05/31/2015 06:32:21 PM Eastern Daylight Time		05/27/2015 05:44:55 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	190	0	2016	Upper MW and N Plains (IA,MN,NE,SD,ND,WY,MT)		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	191	0		29	10	S5768_191_0	2		1	05/31/2015	2016.01	05/31/2015 06:33:17 PM Eastern Daylight Time		05/27/2015 05:45:13 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	191	0	2016	New Mexico		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	192	0		29	10	S5768_192_0	2		1	05/31/2015	2016.01	05/31/2015 06:34:18 PM Eastern Daylight Time		05/27/2015 05:45:31 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	192	0	2016	Oregon, Washington		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	193	0		29	10	S5768_193_0	2		1	05/31/2015	2016.01	05/31/2015 06:35:45 PM Eastern Daylight Time		05/27/2015 05:45:50 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	193	0	2016	Idaho, Utah		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	194	0		29	10	S5768_194_0	2		1	05/31/2015	2016.01	05/31/2015 06:36:38 PM Eastern Daylight Time		05/27/2015 05:46:08 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	194	0	2016	California		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	195	0		29	10	S5768_195_0	2		1	05/31/2015	2016.01	05/31/2015 06:38:02 PM Eastern Daylight Time		05/27/2015 05:46:26 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	195	0	2016	Hawaii		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	196	0		29	10	S5768_196_0	2		1	05/31/2015	2016.01	05/31/2015 06:38:54 PM Eastern Daylight Time		05/27/2015 05:46:44 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	196	0	2016	Alaska		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	197	0		29	10	S5768_197_0	1		1	05/22/2015	2016.01	05/22/2015 05:12:33 PM Eastern Daylight Time		05/27/2015 05:47:03 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	197	0	2016	Alaska		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	198	0		29	10	S5768_198_0	2		1	05/29/2015	2016.01	05/29/2015 08:11:48 AM Eastern Daylight Time		05/27/2015 05:47:20 PM Eastern Daylight Time			05/29/2015 08:12:30 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	198	0	2016	Hawaii		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	199	0		29	10	S5768_199_0	2		1	05/31/2015	2016.01	05/31/2015 06:40:52 PM Eastern Daylight Time		05/27/2015 05:47:38 PM Eastern Daylight Time			05/31/2015 08:50:53 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	199	0	2016	New York		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5768	200	0		29	10	S5768_200_0	1		1	05/27/2015	2016.01	05/27/2015 12:55:10 PM Eastern Daylight Time		05/27/2015 05:47:57 PM Eastern Daylight Time			05/28/2015 06:57:00 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	200	0	2016	New York		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)389-9688		(855)389-9688										(711)-		(711)-		(711)-		(711)-																
S5795	002	0		29	10	S5795_002_0	3		1	05/26/2015	2016.01	05/26/2015 12:49:48 PM Central Daylight Time		06/01/2015 09:20:36 AM Central Daylight Time			06/01/2015 09:23:00 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Rx Premier (PDP)	10	29					S5795	002	0	2016	State of Arkansas		2					2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	003	0		29	10	S5795_003_0	3		1	05/29/2015	2016.01	05/29/2015 08:53:08 AM Central Daylight Time		06/01/2015 09:20:36 AM Central Daylight Time			06/01/2015 09:23:00 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Rx Basic (PDP)	10	29					S5795	003	0	2016	State of Arkansas		2					2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	804	0		29	10	S5795_804_0	1		1	05/26/2015	2016.01	05/26/2015 01:22:05 PM Central Daylight Time					05/26/2015 02:01:20 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	Arkansas BCBS Std Def Employer CY 4 (PDP)	10	29					S5795	804	0	2016	Employer Group Plan		1					2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	809	0		29	10	S5795_809_0	1		1	05/26/2015	2016.01	05/26/2015 01:58:56 PM Central Daylight Time					05/26/2015 02:01:20 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	Arkansas BCBS Std Def Employer NCY 4 (PDP)	10	29					S5795	809	0	2016	Employer Group Plan		1					2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	811	0		29	10	S5795_811_0	1		1	05/26/2015	2016.01	05/26/2015 01:59:02 PM Central Daylight Time					05/26/2015 02:01:20 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	ABCBS Group Basic CY (PDP)	10	29					S5795	811	0	2016	Employer Group Plan		1					2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	812	0		29	10	S5795_812_0	1		1	05/26/2015	2016.01	05/26/2015 01:59:06 PM Central Daylight Time					05/26/2015 02:01:20 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	ABCBS Group Basic PY (PDP)	10	29					S5795	812	0	2016	Employer Group Plan		1					2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5805	001	0		29	10	S5805_001_0	2		1	05/29/2015	2016.01	05/29/2015 04:48:14 PM Central Daylight Time		05/29/2015 10:01:18 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5805	001	0	2016	New York		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	3		1	04/14/2015	2016.01	04/14/2015 09:59:44 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	803	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	804	0		29	10	S5805_804_0	3		1	04/14/2015	2016.01	04/14/2015 09:59:48 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	804	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	807	0		29	10	S5805_807_0	3		1	04/14/2015	2016.01	04/14/2015 09:59:50 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	807	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	808	0		29	10	S5805_808_0	3		1	04/14/2015	2016.01	04/14/2015 09:59:57 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	808	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	809	0		29	10	S5805_809_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:00 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	809	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	810	0		29	10	S5805_810_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:03 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	810	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	811	0		29	10	S5805_811_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:06 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	811	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	812	0		29	10	S5805_812_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:11 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	812	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	813	0		29	10	S5805_813_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:14 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	813	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	814	0		29	10	S5805_814_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:17 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	814	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	815	0		29	10	S5805_815_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:47 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	815	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	816	0		29	10	S5805_816_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:50 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	816	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	818	0		29	10	S5805_818_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:53 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	818	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	819	0		29	10	S5805_819_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:56 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	819	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	820	0		29	10	S5805_820_0	3		1	04/14/2015	2016.01	04/14/2015 10:00:59 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	820	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	821	0		29	10	S5805_821_0	3		1	04/14/2015	2016.01	04/14/2015 10:01:01 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	821	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	822	0		29	10	S5805_822_0	3		1	04/14/2015	2016.01	04/14/2015 10:01:04 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	822	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	823	0		29	10	S5805_823_0	3		1	04/14/2015	2016.01	04/14/2015 10:01:08 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	823	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	824	0		29	10	S5805_824_0	3		1	04/14/2015	2016.01	04/14/2015 10:01:11 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	824	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	825	0		29	10	S5805_825_0	3		1	04/14/2015	2016.01	04/14/2015 10:01:14 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	825	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	826	0		29	10	S5805_826_0	3		1	04/14/2015	2016.01	04/14/2015 10:01:18 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	826	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	827	0		29	10	S5805_827_0	3		1	04/14/2015	2016.01	04/14/2015 10:01:22 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	827	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	828	0		29	10	S5805_828_0	3		1	04/14/2015	2016.01	04/14/2015 10:01:25 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	828	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5810	035	0		29	10	S5810_035_0	2		1	05/27/2015	2016.01	05/27/2015 05:25:09 PM Eastern Daylight Time		05/27/2015 05:48:15 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	035	0	2016	Northern New England (NH, ME)		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	036	0		29	10	S5810_036_0	1		1	05/20/2015	2016.01	05/20/2015 06:08:08 PM Eastern Daylight Time		05/27/2015 05:48:33 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	036	0	2016	Central New England  (CT,RI, MA,VT)		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	037	0		29	10	S5810_037_0	1		1	05/20/2015	2016.01	05/20/2015 06:23:23 PM Eastern Daylight Time		05/27/2015 05:48:52 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	037	0	2016	New  York		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	038	0		29	10	S5810_038_0	1		1	05/20/2015	2016.01	05/20/2015 06:11:40 PM Eastern Daylight Time		05/27/2015 05:49:10 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	038	0	2016	New Jersey		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	039	0		29	10	S5810_039_0	1		1	05/20/2015	2016.01	05/20/2015 06:35:36 PM Eastern Daylight Time		05/27/2015 05:49:28 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	039	0	2016	Mid-Atlantic (DE,DC,MD)		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	040	0		29	10	S5810_040_0	1		1	05/20/2015	2016.01	05/20/2015 06:15:36 PM Eastern Daylight Time		05/27/2015 05:49:47 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	040	0	2016	Pennsylvania, West Virginia		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	041	0		29	10	S5810_041_0	1		1	05/20/2015	2016.01	05/20/2015 06:32:39 PM Eastern Daylight Time		05/27/2015 05:50:05 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	041	0	2016	Virginia		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	042	0		29	10	S5810_042_0	1		1	05/20/2015	2016.01	05/20/2015 06:10:02 PM Eastern Daylight Time		05/27/2015 05:50:23 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	042	0	2016	North Carolina		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	043	0		29	10	S5810_043_0	1		1	05/20/2015	2016.01	05/20/2015 06:39:24 PM Eastern Daylight Time		05/27/2015 05:50:41 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	043	0	2016	South Carolina		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	044	0		29	10	S5810_044_0	1		1	05/20/2015	2016.01	05/20/2015 05:53:45 PM Eastern Daylight Time		05/27/2015 05:51:00 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	044	0	2016	Georgia		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	045	0		29	10	S5810_045_0	1		1	05/21/2015	2016.01	05/21/2015 08:03:44 AM Eastern Daylight Time		05/27/2015 05:51:18 PM Eastern Daylight Time			05/28/2015 09:58:24 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	045	0	2016	Florida		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	046	0		29	10	S5810_046_0	1		1	05/20/2015	2016.01	05/20/2015 05:56:07 PM Eastern Daylight Time		05/27/2015 05:51:36 PM Eastern Daylight Time			05/28/2015 10:11:18 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	046	0	2016	Alabama, Tennessee		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	047	0		29	10	S5810_047_0	1		1	05/20/2015	2016.01	05/20/2015 05:34:40 PM Eastern Daylight Time		05/27/2015 05:51:55 PM Eastern Daylight Time			05/28/2015 10:11:18 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	047	0	2016	Michigan		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	048	0		29	10	S5810_048_0	1		1	05/20/2015	2016.01	05/20/2015 05:57:13 PM Eastern Daylight Time		05/27/2015 05:52:13 PM Eastern Daylight Time			05/28/2015 10:11:18 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	048	0	2016	Ohio		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	049	0		29	10	S5810_049_0	1		1	05/20/2015	2016.01	05/20/2015 05:51:18 PM Eastern Daylight Time		05/27/2015 05:52:32 PM Eastern Daylight Time			05/28/2015 10:11:18 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	049	0	2016	Indiana, Kentucky		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	050	0		29	10	S5810_050_0	1		1	05/20/2015	2016.01	05/20/2015 05:29:51 PM Eastern Daylight Time		05/27/2015 05:52:50 PM Eastern Daylight Time			05/28/2015 10:11:18 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	050	0	2016	Wisconsin		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	051	0		29	10	S5810_051_0	1		1	05/20/2015	2016.01	05/20/2015 06:03:43 PM Eastern Daylight Time		05/27/2015 05:53:08 PM Eastern Daylight Time			05/28/2015 10:11:18 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	051	0	2016	Illinois		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	052	0		29	10	S5810_052_0	1		1	05/20/2015	2016.01	05/20/2015 05:37:51 PM Eastern Daylight Time		05/27/2015 05:53:27 PM Eastern Daylight Time			05/28/2015 10:11:18 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	052	0	2016	Missouri		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	053	0		29	10	S5810_053_0	1		1	05/20/2015	2016.01	05/20/2015 06:38:32 PM Eastern Daylight Time		05/27/2015 05:53:45 PM Eastern Daylight Time			05/28/2015 10:11:18 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	053	0	2016	Arkansas		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	054	0		29	10	S5810_054_0	1		1	05/20/2015	2016.01	05/20/2015 06:16:44 PM Eastern Daylight Time		05/27/2015 05:54:04 PM Eastern Daylight Time			05/28/2015 10:11:18 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	054	0	2016	Mississippi		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	055	0		29	10	S5810_055_0	2		1	05/31/2015	2016.01	05/31/2015 06:00:39 PM Eastern Daylight Time		05/27/2015 05:54:22 PM Eastern Daylight Time			05/31/2015 06:03:28 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	055	0	2016	Louisiana		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	056	0		29	10	S5810_056_0	1		1	05/20/2015	2016.01	05/20/2015 06:25:15 PM Eastern Daylight Time		05/27/2015 05:54:40 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	056	0	2016	Texas		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	057	0		29	10	S5810_057_0	1		1	05/20/2015	2016.01	05/20/2015 05:24:16 PM Eastern Daylight Time		05/27/2015 05:54:58 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	057	0	2016	Oklahoma		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	058	0		29	10	S5810_058_0	1		1	05/20/2015	2016.01	05/20/2015 05:32:32 PM Eastern Daylight Time		05/27/2015 05:55:16 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	058	0	2016	Kansas		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	059	0		29	10	S5810_059_0	1		1	05/20/2015	2016.01	05/20/2015 05:40:13 PM Eastern Daylight Time		05/27/2015 05:55:34 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	059	0	2016	Upper MW and N Plains (IA,MN,NE,SD,ND,WY,MT)		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	060	0		29	10	S5810_060_0	1		1	05/20/2015	2016.01	05/20/2015 05:41:00 PM Eastern Daylight Time		05/27/2015 05:55:52 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	060	0	2016	New Mexico		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	061	0		29	10	S5810_061_0	1		1	05/20/2015	2016.01	05/20/2015 05:20:56 PM Eastern Daylight Time		05/27/2015 05:56:11 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	061	0	2016	Colorado		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	062	0		29	10	S5810_062_0	1		1	05/20/2015	2016.01	05/20/2015 06:00:07 PM Eastern Daylight Time		05/27/2015 05:56:29 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	062	0	2016	Arizona		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	063	0		29	10	S5810_063_0	1		1	05/20/2015	2016.01	05/20/2015 06:20:10 PM Eastern Daylight Time		05/27/2015 05:56:48 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	063	0	2016	Nevada		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	064	0		29	10	S5810_064_0	1		1	05/20/2015	2016.01	05/20/2015 05:27:05 PM Eastern Daylight Time		05/27/2015 05:57:06 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	064	0	2016	Oregon, Washington		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	065	0		29	10	S5810_065_0	1		1	05/20/2015	2016.01	05/20/2015 05:42:05 PM Eastern Daylight Time		05/27/2015 05:57:25 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	065	0	2016	Idaho, Utah		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	066	0		29	10	S5810_066_0	1		1	05/20/2015	2016.01	05/20/2015 06:06:03 PM Eastern Daylight Time		05/27/2015 05:57:43 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	066	0	2016	California		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	067	0		29	10	S5810_067_0	1		1	05/20/2015	2016.01	05/20/2015 06:19:42 PM Eastern Daylight Time		05/27/2015 05:58:01 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	067	0	2016	Hawaii		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	068	0		29	10	S5810_068_0	1		1	05/22/2015	2016.01	05/22/2015 09:06:42 AM Eastern Daylight Time		05/27/2015 05:58:19 PM Eastern Daylight Time			05/28/2015 11:05:22 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	068	0	2016	Alaska		2					2								http://www.aetnamedicare.com/2016formulary	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5810	801	0		29	10	S5810_801_0	1		1	05/27/2015	2016.01	05/27/2015 05:24:57 PM Eastern Daylight Time					05/28/2015 11:11:19 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Plan (PDP)	10	29					S5810	801	0	2016	Employer National		1					2								http://www.aetnamedicare.com/help_and_resources/downloadable-forms-2015.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(855)338-7030		(855)338-7030										(711)-		(711)-		(711)-		(711)-																
S5820	001	0		29	10	S5820_001_0	2		1	05/29/2015	2016.01	05/29/2015 11:59:30 AM Central Daylight Time		05/29/2015 10:01:30 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	001	0	2016	Northern New England (NH, ME)		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	002	0		29	10	S5820_002_0	2		1	05/29/2015	2016.01	05/29/2015 11:59:51 AM Central Daylight Time		05/29/2015 10:01:43 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	002	0	2016	Central New England (CT, MA, RI, VT)		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	003	0		29	10	S5820_003_0	2		1	05/29/2015	2016.01	05/29/2015 12:00:16 PM Central Daylight Time		05/29/2015 10:01:56 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	003	0	2016	New Jersey		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	004	0		29	10	S5820_004_0	2		1	05/29/2015	2016.01	05/29/2015 12:00:36 PM Central Daylight Time		05/29/2015 10:02:09 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	004	0	2016	Mid-Atlantic (DE, DC, MD)		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	005	0		29	10	S5820_005_0	2		1	05/29/2015	2016.01	05/29/2015 12:01:02 PM Central Daylight Time		05/29/2015 10:02:22 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	005	0	2016	Pennsylvania, West Virginia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	006	0		29	10	S5820_006_0	2		1	05/29/2015	2016.01	05/29/2015 12:01:22 PM Central Daylight Time		05/29/2015 10:02:35 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	006	0	2016	Virginia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	007	0		29	10	S5820_007_0	2		1	05/29/2015	2016.01	05/29/2015 12:01:44 PM Central Daylight Time		05/29/2015 10:02:48 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	007	0	2016	North Carolina		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	008	0		29	10	S5820_008_0	2		1	05/29/2015	2016.01	05/29/2015 12:02:04 PM Central Daylight Time		05/29/2015 10:03:01 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	008	0	2016	South Carolina		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	009	0		29	10	S5820_009_0	2		1	05/29/2015	2016.01	05/29/2015 12:02:28 PM Central Daylight Time		05/29/2015 10:03:14 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	009	0	2016	Georgia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	010	0		29	10	S5820_010_0	2		1	05/29/2015	2016.01	05/29/2015 12:02:48 PM Central Daylight Time		05/29/2015 10:06:15 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	010	0	2016	Florida		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	011	0		29	10	S5820_011_0	2		1	06/01/2015	2016.01	06/01/2015 02:43:01 PM Central Daylight Time		05/29/2015 10:06:28 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	011	0	2016	Alabama, Tennessee		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	012	0		29	10	S5820_012_0	2		1	05/29/2015	2016.01	05/29/2015 12:03:40 PM Central Daylight Time		05/29/2015 10:06:41 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	012	0	2016	Michigan		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	013	0		29	10	S5820_013_0	2		1	05/29/2015	2016.01	05/29/2015 12:04:09 PM Central Daylight Time		05/29/2015 10:06:54 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	013	0	2016	Ohio		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	014	0		29	10	S5820_014_0	2		1	05/29/2015	2016.01	05/29/2015 12:04:30 PM Central Daylight Time		05/29/2015 10:07:07 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	014	0	2016	Indiana, Kentucky		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	015	0		29	10	S5820_015_0	2		1	05/29/2015	2016.01	05/29/2015 12:04:56 PM Central Daylight Time		05/29/2015 10:07:20 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	015	0	2016	Wisconsin		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	016	0		29	10	S5820_016_0	2		1	05/29/2015	2016.01	05/29/2015 12:05:25 PM Central Daylight Time		05/29/2015 10:07:32 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	016	0	2016	Illinois		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	017	0		29	10	S5820_017_0	2		1	05/29/2015	2016.01	05/29/2015 12:05:49 PM Central Daylight Time		05/29/2015 10:07:46 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	017	0	2016	Missouri		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	018	0		29	10	S5820_018_0	2		1	05/29/2015	2016.01	05/29/2015 12:06:20 PM Central Daylight Time		05/29/2015 10:07:58 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	018	0	2016	Arkansas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	019	0		29	10	S5820_019_0	2		1	05/29/2015	2016.01	05/29/2015 12:06:45 PM Central Daylight Time		05/29/2015 10:08:12 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	019	0	2016	Mississippi		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	020	0		29	10	S5820_020_0	2		1	05/29/2015	2016.01	05/29/2015 12:07:09 PM Central Daylight Time		05/29/2015 10:08:55 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	020	0	2016	Louisiana		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	021	0		29	10	S5820_021_0	2		1	05/29/2015	2016.01	05/29/2015 12:08:11 PM Central Daylight Time		05/29/2015 10:09:08 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	021	0	2016	Texas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	022	0		29	10	S5820_022_0	2		1	05/29/2015	2016.01	05/29/2015 12:08:34 PM Central Daylight Time		05/29/2015 10:09:21 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	022	0	2016	Oklahoma		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	023	0		29	10	S5820_023_0	2		1	05/29/2015	2016.01	05/29/2015 12:08:55 PM Central Daylight Time		05/29/2015 10:09:33 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	023	0	2016	Kansas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	024	0		29	10	S5820_024_0	2		1	05/29/2015	2016.01	05/29/2015 12:09:21 PM Central Daylight Time		05/29/2015 10:09:46 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	024	0	2016	Upper Midwest and Northern Plains		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	025	0		29	10	S5820_025_0	2		1	05/29/2015	2016.01	05/29/2015 12:09:39 PM Central Daylight Time		05/29/2015 10:03:56 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	025	0	2016	New Mexico		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	026	0		29	10	S5820_026_0	2		1	05/29/2015	2016.01	05/29/2015 12:10:03 PM Central Daylight Time		05/29/2015 10:04:09 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	026	0	2016	Colorado		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	027	0		29	10	S5820_027_0	2		1	05/29/2015	2016.01	05/29/2015 12:10:37 PM Central Daylight Time		05/29/2015 10:04:22 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	027	0	2016	Arizona		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	028	0		29	10	S5820_028_0	2		1	05/29/2015	2016.01	05/29/2015 12:11:08 PM Central Daylight Time		05/29/2015 10:04:35 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	028	0	2016	Nevada		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	029	0		29	10	S5820_029_0	2		1	05/29/2015	2016.01	05/29/2015 12:11:32 PM Central Daylight Time		05/29/2015 10:04:49 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	029	0	2016	Oregon, Washington		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	030	0		29	10	S5820_030_0	2		1	05/29/2015	2016.01	05/29/2015 12:11:50 PM Central Daylight Time		05/29/2015 10:05:02 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	030	0	2016	Idaho, Utah		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	031	0		29	10	S5820_031_0	2		1	05/29/2015	2016.01	05/29/2015 12:12:29 PM Central Daylight Time		05/29/2015 10:05:15 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	031	0	2016	California		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	032	0		29	10	S5820_032_0	2		1	05/29/2015	2016.01	05/29/2015 12:13:00 PM Central Daylight Time		05/29/2015 10:05:29 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	032	0	2016	Hawaii		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	033	0		29	10	S5820_033_0	2		1	05/29/2015	2016.01	05/29/2015 12:13:20 PM Central Daylight Time		05/29/2015 10:05:42 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	033	0	2016	Alaska		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	034	0		29	10	S5820_034_0	2		1	06/01/2015	2016.01	06/01/2015 02:01:11 PM Central Daylight Time		05/29/2015 10:05:56 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	034	0	2016	American Samoa		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	035	0		29	10	S5820_035_0	2		1	05/29/2015	2016.01	05/29/2015 12:14:24 PM Central Daylight Time		05/29/2015 10:06:10 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	035	0	2016	Guam		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	036	0		29	10	S5820_036_0	2		1	05/29/2015	2016.01	05/29/2015 12:14:39 PM Central Daylight Time		05/29/2015 10:06:24 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	036	0	2016	Northern Mariana Islands		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	037	0		29	10	S5820_037_0	2		1	05/29/2015	2016.01	05/29/2015 12:15:01 PM Central Daylight Time		05/29/2015 10:06:38 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	037	0	2016	Puerto Rico		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:15:22 PM Central Daylight Time		05/29/2015 10:06:51 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	038	0	2016	US Virgin Islands		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	3		1	04/14/2015	2016.01	04/14/2015 10:03:24 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	803	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	804	0		29	10	S5820_804_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:26 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	804	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	807	0		29	10	S5820_807_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:29 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	807	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	808	0		29	10	S5820_808_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:31 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	808	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	810	0		29	10	S5820_810_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:33 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	810	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	811	0		29	10	S5820_811_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:36 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	811	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	812	0		29	10	S5820_812_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:39 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	812	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	813	0		29	10	S5820_813_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:42 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	813	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	814	0		29	10	S5820_814_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:45 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	814	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	815	0		29	10	S5820_815_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:47 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	815	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	816	0		29	10	S5820_816_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:49 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	816	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	817	0		29	10	S5820_817_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:52 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	817	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	818	0		29	10	S5820_818_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:56 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	818	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	819	0		29	10	S5820_819_0	3		1	04/14/2015	2016.01	04/14/2015 10:03:59 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	819	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	820	0		29	10	S5820_820_0	3		1	04/14/2015	2016.01	04/14/2015 10:04:01 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	820	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	821	0		29	10	S5820_821_0	3		1	04/14/2015	2016.01	04/14/2015 10:04:04 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	821	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	822	0		29	10	S5820_822_0	3		1	04/14/2015	2016.01	04/14/2015 10:04:06 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	822	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	823	0		29	10	S5820_823_0	3		1	04/14/2015	2016.01	04/14/2015 10:04:12 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	823	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	824	0		29	10	S5820_824_0	3		1	04/14/2015	2016.01	04/14/2015 10:04:15 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	824	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	825	0		29	10	S5820_825_0	3		1	04/14/2015	2016.01	04/14/2015 10:04:18 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	825	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	826	0		29	10	S5820_826_0	3		1	04/14/2015	2016.01	04/14/2015 10:04:21 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	826	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5857	802	0		29	10	S5857_802_0	3		1	05/17/2015	2016.01	05/17/2015 01:39:56 PM Eastern Daylight Time					06/01/2015 08:37:45 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	2016	United States		1					2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com									(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-																
S5857	803	0		29	10	S5857_803_0	3		1	05/17/2015	2016.01	05/17/2015 01:40:16 PM Eastern Daylight Time					06/01/2015 08:37:45 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	2016	United States		1					2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com									(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-																
S5877	004	0		29	10	S5877_004_0	5		1	06/02/2015	2016.01	06/02/2015 11:07:07 AM Mountain Daylight Time		06/01/2015 08:12:31 PM Mountain Daylight Time			06/02/2015 11:08:10 AM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	http://medicare.emihealth.com/	Educators Rx Basic (PDP)	10	29					S5877	004	0	2016	State of Utah and State of Idaho		2					2								https://medicare.emihealth.com/Formulary.aspx	http://www.express-scripts.com									(800)572-8734		(801)262-7475		(888)236-4823		(801)262-7475										(800)716-3231		(800)716-3231		(711)-		(711)-																
S5877	007	0		29	10	S5877_007_0	3		1	06/01/2015	2016.01	06/01/2015 08:09:00 PM Mountain Daylight Time		06/01/2015 08:12:31 PM Mountain Daylight Time			06/01/2015 08:15:53 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	http://medicare.emihealth.com/	Educators Rx Advantage (PDP)	10	29					S5877	007	0	2016	State of Utah and State of Idaho		2					2								https://medicare.emihealth.com/Formulary.aspx	http://www.express-scripts.com									(800)572-8734		(801)262-7475		(888)236-4823		(801)262-7475										(800)716-3231		(800)716-3231		(711)-		(711)-																
S5877	801	0		29	10	S5877_801_0	2		1	05/26/2015	2016.01	05/26/2015 03:37:04 PM Mountain Daylight Time					05/29/2015 05:46:00 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	http://medicare.emihealth.com/	Alpine School District Retiree Plan (PDP)	10	29					S5877	801	0	2016	State of Utah and State of Idaho		1					2								https://medicare.emihealth.com/Formulary.aspx	http://www.express-scripts.com									(800)572-8734		(801)262-7475		(888)236-4823		(801)262-7475										(800)716-3231		(800)716-3231		(711)-		(711)-																
S5884	001	0		29	10	S5884_001_0	1		1	05/22/2015	2016.01	05/22/2015 02:45:46 PM Eastern Daylight Time		05/23/2015 12:08:30 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	001	0	2016	States of Alabama and Tennessee		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	002	0		29	10	S5884_002_0	1		1	05/22/2015	2016.01	05/22/2015 02:46:26 PM Eastern Daylight Time		05/23/2015 12:09:02 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	002	0	2016	States of CT, MA, RI, VT		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	004	0		29	10	S5884_004_0	1		1	05/22/2015	2016.01	05/22/2015 02:46:53 PM Eastern Daylight Time		05/23/2015 12:09:34 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	004	0	2016	States of DC, DE, MD		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	005	0		29	10	S5884_005_0	1		1	05/22/2015	2016.01	05/22/2015 02:48:10 PM Eastern Daylight Time		05/23/2015 12:10:06 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	005	0	2016	States of Pennsylvania and West Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	008	0		29	10	S5884_008_0	1		1	05/22/2015	2016.01	05/22/2015 02:48:45 PM Eastern Daylight Time		05/23/2015 12:10:38 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	008	0	2016	State of South Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	009	0		29	10	S5884_009_0	1		1	05/22/2015	2016.01	05/22/2015 02:49:15 PM Eastern Daylight Time		05/23/2015 12:11:10 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	009	0	2016	State of Georgia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	010	0		29	10	S5884_010_0	1		1	05/22/2015	2016.01	05/22/2015 02:49:43 PM Eastern Daylight Time		05/23/2015 12:11:42 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	010	0	2016	State of Florida		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	015	0		29	10	S5884_015_0	1		1	05/22/2015	2016.01	05/22/2015 02:51:44 PM Eastern Daylight Time		05/23/2015 12:12:16 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	015	0	2016	State of Illinois		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	019	0		29	10	S5884_019_0	1		1	05/22/2015	2016.01	05/22/2015 02:52:08 PM Eastern Daylight Time		05/23/2015 12:12:48 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	019	0	2016	State of Louisiana		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	020	0		29	10	S5884_020_0	1		1	05/22/2015	2016.01	05/22/2015 02:52:34 PM Eastern Daylight Time		05/23/2015 12:13:20 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	020	0	2016	State of Texas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	021	0		29	10	S5884_021_0	1		1	05/22/2015	2016.01	05/22/2015 02:52:57 PM Eastern Daylight Time		05/23/2015 12:13:52 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	021	0	2016	State of Oklahoma		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	022	0		29	10	S5884_022_0	1		1	05/22/2015	2016.01	05/22/2015 02:53:19 PM Eastern Daylight Time		05/23/2015 12:14:24 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	022	0	2016	State of Kansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	024	0		29	10	S5884_024_0	1		1	05/22/2015	2016.01	05/22/2015 02:53:42 PM Eastern Daylight Time		05/23/2015 12:14:56 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	024	0	2016	State of New Mexico		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	028	0		29	10	S5884_028_0	1		1	05/22/2015	2016.01	05/22/2015 02:54:14 PM Eastern Daylight Time		05/23/2015 12:15:28 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	028	0	2016	States of Oregon and Washington		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	030	0		29	10	S5884_030_0	2		1	05/22/2015	2016.01	05/22/2015 02:54:40 PM Eastern Daylight Time		05/23/2015 12:16:00 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	030	0	2016	State of California		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	062	0		29	10	S5884_062_0	1		1	05/22/2015	2016.01	05/22/2015 02:55:12 PM Eastern Daylight Time		05/23/2015 12:16:32 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	062	0	2016	State of New Jersey		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	065	0		29	10	S5884_065_0	1		1	05/22/2015	2016.01	05/22/2015 02:55:38 PM Eastern Daylight Time		05/23/2015 12:17:04 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	065	0	2016	State of Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	066	0		29	10	S5884_066_0	1		1	05/22/2015	2016.01	05/22/2015 02:56:13 PM Eastern Daylight Time		05/23/2015 12:17:36 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	066	0	2016	State of North Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	071	0		29	10	S5884_071_0	1		1	05/22/2015	2016.01	05/22/2015 02:56:40 PM Eastern Daylight Time		05/23/2015 12:18:06 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	071	0	2016	State of Michigan		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	072	0		29	10	S5884_072_0	1		1	05/22/2015	2016.01	05/22/2015 02:57:09 PM Eastern Daylight Time		05/23/2015 12:18:38 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	072	0	2016	State of Ohio		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	073	0		29	10	S5884_073_0	1		1	05/22/2015	2016.01	05/22/2015 02:57:35 PM Eastern Daylight Time		05/23/2015 12:19:10 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	073	0	2016	States of Indiana and Kentucky		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	074	0		29	10	S5884_074_0	1		1	05/22/2015	2016.01	05/22/2015 02:58:10 PM Eastern Daylight Time		05/23/2015 12:19:42 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	074	0	2016	State of Wisconsin		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	076	0		29	10	S5884_076_0	1		1	05/22/2015	2016.01	05/22/2015 02:58:37 PM Eastern Daylight Time		05/23/2015 12:20:14 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	076	0	2016	State of Missouri		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	077	0		29	10	S5884_077_0	1		1	05/22/2015	2016.01	05/22/2015 02:59:11 PM Eastern Daylight Time		05/23/2015 12:20:46 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	077	0	2016	State of Arkansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	078	0		29	10	S5884_078_0	1		1	05/22/2015	2016.01	05/22/2015 02:59:43 PM Eastern Daylight Time		05/23/2015 12:21:18 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	078	0	2016	State of Mississippi		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	083	0		29	10	S5884_083_0	1		1	05/22/2015	2016.01	05/22/2015 03:00:08 PM Eastern Daylight Time		05/23/2015 12:21:52 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	083	0	2016	States of IA, MN, MT, ND, NE, SD, WY		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	085	0		29	10	S5884_085_0	1		1	05/22/2015	2016.01	05/22/2015 03:00:38 PM Eastern Daylight Time		05/23/2015 12:22:24 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	085	0	2016	State of Colorado		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	086	0		29	10	S5884_086_0	1		1	05/22/2015	2016.01	05/22/2015 03:01:01 PM Eastern Daylight Time		05/23/2015 12:22:56 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	086	0	2016	State of Arizona		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	087	0		29	10	S5884_087_0	1		1	05/22/2015	2016.01	05/22/2015 03:01:27 PM Eastern Daylight Time		05/23/2015 12:23:28 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	087	0	2016	State of Nevada		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	089	0		29	10	S5884_089_0	1		1	05/22/2015	2016.01	05/22/2015 03:02:00 PM Eastern Daylight Time		05/23/2015 12:24:02 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	089	0	2016	States of Idaho and Utah		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	092	0		29	10	S5884_092_0	1		1	05/22/2015	2016.01	05/22/2015 03:02:36 PM Eastern Daylight Time		05/23/2015 12:24:34 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	092	0	2016	States of Maine and New Hampshire		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	093	0		29	10	S5884_093_0	1		1	05/22/2015	2016.01	05/22/2015 03:03:04 PM Eastern Daylight Time		05/23/2015 12:25:06 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	093	0	2016	State of Hawaii		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	094	0		29	10	S5884_094_0	1		1	05/22/2015	2016.01	05/22/2015 03:03:29 PM Eastern Daylight Time		05/23/2015 12:25:38 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	094	0	2016	State of Alaska		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	101	0		29	10	S5884_101_0	1		1	05/22/2015	2016.01	05/22/2015 03:04:10 PM Eastern Daylight Time		05/23/2015 12:26:10 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	101	0	2016	States of New Hampshire and Maine		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	102	0		29	10	S5884_102_0	2		1	05/24/2015	2016.01	05/24/2015 01:03:50 AM Eastern Daylight Time		05/23/2015 12:26:42 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	102	0	2016	States of CT, MA, RI, VT		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:05:19 PM Eastern Daylight Time		05/23/2015 12:27:12 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	103	0	2016	States of DC, DE, MD		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:05:47 PM Eastern Daylight Time		05/23/2015 12:27:44 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	104	0	2016	States of Pennsylvania and West Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:06:13 PM Eastern Daylight Time		05/23/2015 12:28:16 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	105	0	2016	State of Florida		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:06:42 PM Eastern Daylight Time		05/23/2015 12:28:50 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	106	0	2016	States of Alabama and Tennessee		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:07:13 PM Eastern Daylight Time		05/23/2015 12:29:22 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	107	0	2016	State of Illinois		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:08:53 PM Eastern Daylight Time		05/23/2015 12:29:54 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	108	0	2016	State of Louisiana		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:07:58 PM Eastern Daylight Time		05/23/2015 12:30:26 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	109	0	2016	State of Kansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:08:30 PM Eastern Daylight Time		05/23/2015 12:30:58 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	110	0	2016	State of New Mexico		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:09:23 PM Eastern Daylight Time		05/23/2015 12:31:30 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	111	0	2016	State of Colorado		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:10:01 PM Eastern Daylight Time		05/23/2015 12:32:02 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	112	0	2016	State of Nevada		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:10:31 PM Eastern Daylight Time		05/23/2015 12:32:36 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	113	0	2016	States of Oregon and Washington		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:11:03 PM Eastern Daylight Time		05/23/2015 12:33:08 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	114	0	2016	State of California		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/24/2015	2016.01	05/24/2015 01:13:19 AM Eastern Daylight Time		05/23/2015 12:33:40 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	115	0	2016	State of Hawaii		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:12:04 PM Eastern Daylight Time		05/23/2015 12:34:12 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	116	0	2016	State of Alaska		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:12:31 PM Eastern Daylight Time		05/23/2015 12:34:44 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	131	0	2016	State of New Jersey		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	132	0		29	10	S5884_132_0	1		1	05/22/2015	2016.01	05/22/2015 03:12:58 PM Eastern Daylight Time		05/23/2015 12:35:16 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	132	0	2016	State of Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:13:30 PM Eastern Daylight Time		05/23/2015 12:35:50 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	133	0	2016	State of North Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/26/2015	2016.01	05/26/2015 11:36:29 AM Eastern Daylight Time		05/23/2015 12:36:22 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	134	0	2016	State of South Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:14:32 PM Eastern Daylight Time		05/23/2015 12:36:54 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	135	0	2016	State of Georgia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:15:04 PM Eastern Daylight Time		05/23/2015 12:37:26 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	136	0	2016	State of Michigan		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:15:31 PM Eastern Daylight Time		05/23/2015 12:37:58 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	137	0	2016	State of Ohio		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:16:02 PM Eastern Daylight Time		05/23/2015 12:38:30 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	138	0	2016	States of Indiana and Kentucky		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:16:32 PM Eastern Daylight Time		05/23/2015 12:39:02 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	139	0	2016	State of Wisconsin		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:17:12 PM Eastern Daylight Time		05/23/2015 12:39:34 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	140	0	2016	State of Missouri		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:18:07 PM Eastern Daylight Time		05/23/2015 12:40:08 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	141	0	2016	State of Arkansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:18:39 PM Eastern Daylight Time		05/23/2015 12:40:38 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	142	0	2016	State of Mississippi		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:19:13 PM Eastern Daylight Time		05/23/2015 12:41:10 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	143	0	2016	State of Texas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:19:53 PM Eastern Daylight Time		05/23/2015 12:41:42 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	144	0	2016	State of Oklahoma		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	145	0		29	10	S5884_145_0	1		1	05/22/2015	2016.01	05/22/2015 03:20:25 PM Eastern Daylight Time		05/23/2015 12:42:14 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	145	0	2016	States of IA, MN, MT, ND, NE, SD, WY		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	146	0		29	10	S5884_146_0	1		1	05/22/2015	2016.01	05/22/2015 03:20:58 PM Eastern Daylight Time		05/23/2015 12:42:46 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	146	0	2016	State of Arizona		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:21:30 PM Eastern Daylight Time		05/23/2015 12:43:18 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	147	0	2016	States of Idaho and Utah		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	148	0		29	10	S5884_148_0	1		1	05/22/2015	2016.01	05/22/2015 03:21:48 PM Eastern Daylight Time		05/23/2015 12:43:52 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	148	0	2016	States of New Hampshire and Maine		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	149	0		29	10	S5884_149_0	1		1	05/22/2015	2016.01	05/22/2015 03:22:09 PM Eastern Daylight Time		05/23/2015 12:44:24 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	149	0	2016	States of CT, MA, RI, VT		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	150	0		29	10	S5884_150_0	1		1	05/22/2015	2016.01	05/22/2015 03:22:27 PM Eastern Daylight Time		05/23/2015 12:44:56 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	150	0	2016	State of New Jersey		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	151	0		29	10	S5884_151_0	1		1	05/22/2015	2016.01	05/22/2015 03:22:50 PM Eastern Daylight Time		05/23/2015 12:45:30 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	151	0	2016	States of DC, DE, MD		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	152	0		29	10	S5884_152_0	1		1	05/22/2015	2016.01	05/22/2015 03:23:10 PM Eastern Daylight Time		05/23/2015 12:46:02 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	152	0	2016	States of Pennsylvania and West Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	153	0		29	10	S5884_153_0	1		1	05/22/2015	2016.01	05/22/2015 03:23:41 PM Eastern Daylight Time		05/23/2015 12:46:36 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	153	0	2016	State of Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	154	0		29	10	S5884_154_0	1		1	05/22/2015	2016.01	05/22/2015 03:24:19 PM Eastern Daylight Time		05/23/2015 12:47:08 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	154	0	2016	State of North Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(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	05/22/2015	2016.01	05/22/2015 03:24:40 PM Eastern Daylight Time		05/23/2015 12:47:42 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	155	0	2016	State of South Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	156	0		29	10	S5884_156_0	1		1	05/22/2015	2016.01	05/22/2015 03:25:34 PM Eastern Daylight Time		05/23/2015 12:48:14 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	156	0	2016	State of Georgia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	157	0		29	10	S5884_157_0	1		1	05/22/2015	2016.01	05/22/2015 03:26:00 PM Eastern Daylight Time		05/23/2015 12:48:48 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	157	0	2016	State of Florida		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	158	0		29	10	S5884_158_0	1		1	05/22/2015	2016.01	05/22/2015 03:26:27 PM Eastern Daylight Time		05/23/2015 12:49:20 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	158	0	2016	States of Alabama and Tennessee		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	159	0		29	10	S5884_159_0	1		1	05/22/2015	2016.01	05/22/2015 03:27:24 PM Eastern Daylight Time		05/23/2015 12:49:54 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	159	0	2016	State of Michigan		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	160	0		29	10	S5884_160_0	1		1	05/22/2015	2016.01	05/22/2015 03:28:07 PM Eastern Daylight Time		05/23/2015 12:50:26 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	160	0	2016	State of Ohio		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	161	0		29	10	S5884_161_0	1		1	05/22/2015	2016.01	05/22/2015 03:28:30 PM Eastern Daylight Time		05/23/2015 12:50:58 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	161	0	2016	States of Indiana and Kentucky		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	162	0		29	10	S5884_162_0	1		1	05/22/2015	2016.01	05/22/2015 03:28:51 PM Eastern Daylight Time		05/23/2015 12:51:30 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	162	0	2016	State of Wisconsin		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	163	0		29	10	S5884_163_0	1		1	05/22/2015	2016.01	05/22/2015 03:29:31 PM Eastern Daylight Time		05/23/2015 12:52:02 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	163	0	2016	State of Illinois		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	164	0		29	10	S5884_164_0	1		1	05/22/2015	2016.01	05/22/2015 03:29:59 PM Eastern Daylight Time		05/23/2015 12:52:34 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	164	0	2016	State of Missouri		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	165	0		29	10	S5884_165_0	1		1	05/22/2015	2016.01	05/22/2015 03:30:33 PM Eastern Daylight Time		05/23/2015 12:53:06 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	165	0	2016	State of Arkansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	166	0		29	10	S5884_166_0	1		1	05/22/2015	2016.01	05/22/2015 03:31:01 PM Eastern Daylight Time		05/23/2015 12:53:38 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	166	0	2016	State of Mississippi		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	167	0		29	10	S5884_167_0	1		1	05/22/2015	2016.01	05/22/2015 03:31:42 PM Eastern Daylight Time		05/23/2015 12:54:10 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	167	0	2016	State of Louisiana		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	168	0		29	10	S5884_168_0	1		1	05/22/2015	2016.01	05/22/2015 03:32:06 PM Eastern Daylight Time		05/23/2015 12:54:42 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	168	0	2016	State of Texas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	169	0		29	10	S5884_169_0	1		1	05/22/2015	2016.01	05/22/2015 03:32:44 PM Eastern Daylight Time		05/23/2015 12:55:16 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	169	0	2016	State of Oklahoma		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	170	0		29	10	S5884_170_0	1		1	05/22/2015	2016.01	05/22/2015 03:33:20 PM Eastern Daylight Time		05/23/2015 12:55:48 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	170	0	2016	State of Kansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	171	0		29	10	S5884_171_0	1		1	05/22/2015	2016.01	05/22/2015 03:33:47 PM Eastern Daylight Time		05/23/2015 12:56:20 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	171	0	2016	States of IA, MN, MT, ND, NE, SD, WY		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	172	0		29	10	S5884_172_0	1		1	05/22/2015	2016.01	05/22/2015 03:34:07 PM Eastern Daylight Time		05/23/2015 12:56:52 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	172	0	2016	State of New Mexico		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	173	0		29	10	S5884_173_0	1		1	05/22/2015	2016.01	05/22/2015 03:34:26 PM Eastern Daylight Time		05/23/2015 12:57:24 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	173	0	2016	State of Colorado		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	174	0		29	10	S5884_174_0	1		1	05/22/2015	2016.01	05/22/2015 03:34:59 PM Eastern Daylight Time		05/23/2015 12:57:56 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	174	0	2016	State of Arizona		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	175	0		29	10	S5884_175_0	1		1	05/22/2015	2016.01	05/22/2015 03:35:29 PM Eastern Daylight Time		05/23/2015 12:58:28 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	175	0	2016	State of Nevada		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	176	0		29	10	S5884_176_0	1		1	05/22/2015	2016.01	05/22/2015 03:35:54 PM Eastern Daylight Time		05/23/2015 12:59:00 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	176	0	2016	States of Oregon and Washington		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	177	0		29	10	S5884_177_0	1		1	05/22/2015	2016.01	05/22/2015 03:36:44 PM Eastern Daylight Time		05/23/2015 12:59:32 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	177	0	2016	States of Idaho and Utah		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	178	0		29	10	S5884_178_0	1		1	05/22/2015	2016.01	05/22/2015 03:37:13 PM Eastern Daylight Time		05/23/2015 01:00:04 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	178	0	2016	State of California		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	179	0		29	10	S5884_179_0	1		1	05/22/2015	2016.01	05/22/2015 03:37:33 PM Eastern Daylight Time		05/23/2015 01:00:38 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	179	0	2016	State of Hawaii		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	180	0		29	10	S5884_180_0	1		1	05/22/2015	2016.01	05/22/2015 03:43:50 PM Eastern Daylight Time		05/23/2015 01:01:10 AM Eastern Daylight Time			05/26/2015 01:56:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	180	0	2016	State of Alaska		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	834	0		29	10	S5884_834_0	1		1	05/13/2015	2016.01	05/13/2015 12:37:39 PM Eastern Daylight Time					05/26/2015 02:50:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PDP)	10	29					S5884	834	0	2016	All Regions		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5904	001	0		29	10	S5904_001_0	5		1	06/01/2015	2016.01	06/01/2015 09:49:05 AM Eastern Daylight Time		07/01/2015 05:16:10 PM Eastern Daylight Time			07/20/2015 04:53:29 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Rx-Option 1 (PDP)	10	29					S5904	001	0	2016	State of Florida		2					2								MyPrime.com	www.BlueMedicareFL.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	4		1	06/01/2015	2016.01	06/01/2015 09:49:53 AM Eastern Daylight Time		06/01/2015 02:47:16 PM Eastern Daylight Time			06/01/2015 07:46:23 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Rx-Option 2 (PDP)	10	29					S5904	002	0	2016	State of Florida		2					2								MyPrime.com	www.BlueMedicareFL.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	2		1	05/19/2015	2016.01	05/19/2015 12:36:21 PM Eastern Daylight Time					05/19/2015 12:36:51 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Group Rx (PDP)	10	29					S5904	801	0	2016	State of Florida with National Coverage		1					2								MyPrime.com	www.BlueMedicareFL.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	2		1	05/19/2015	2016.01	05/19/2015 12:35:54 PM Eastern Daylight Time					05/19/2015 12:36:51 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Group Rx (PDP)	10	29					S5904	802	0	2016	State of Florida with National Coverage		1					2								MyPrime.com	www.BlueMedicareFL.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	3		1	06/01/2015	2016.01	06/01/2015 11:22:57 AM Mountain Daylight Time		06/01/2015 03:31:11 PM Mountain Daylight Time			06/01/2015 05:04:35 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script Basic (PDP)	10	29					S5916	001	0	2016	Region of Idaho and Utah		2					2								www.regence.com/medicare	www.regence.com/medicare									(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-																
S5916	002	0		29	10	S5916_002_0	4		1	06/01/2015	2016.01	06/01/2015 11:23:50 AM Mountain Daylight Time		07/20/2015 09:59:05 AM Mountain Daylight Time			07/20/2015 11:11:25 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script Enhanced (PDP)	10	29					S5916	002	0	2016	Region of Idaho and Utah		2					2								www.regence.com/medicare	www.regence.com/medicare									(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-																
S5916	802	0		29	10	S5916_802_0	2		1	05/11/2015	2016.01	05/11/2015 05:15:18 PM Mountain Daylight Time					06/01/2015 05:04:35 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script (PDP)	10	29					S5916	802	0	2016	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	05/29/2015	2016.01	05/29/2015 12:16:19 PM Central Daylight Time		05/29/2015 10:07:05 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	348	0	2016	Connecticut, Massachusetts, Rhode Island, Vermont		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:17:19 PM Central Daylight Time		05/29/2015 10:07:18 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	349	0	2016	New Jersey		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:17:43 PM Central Daylight Time		05/29/2015 10:07:32 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	350	0	2016	Delaware, Maryland and Washington D.C.		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:18:07 PM Central Daylight Time		05/29/2015 10:07:45 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	351	0	2016	Pennsylvania and West Virginia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	2		1	05/29/2015	2016.01	05/29/2015 12:18:31 PM Central Daylight Time		05/29/2015 10:07:59 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	352	0	2016	Virginia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:19:01 PM Central Daylight Time		05/29/2015 10:08:13 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	353	0	2016	North Carolina		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:19:26 PM Central Daylight Time		05/29/2015 10:08:26 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	354	0	2016	South Carolina		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:19:53 PM Central Daylight Time		05/29/2015 10:08:40 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	355	0	2016	Georgia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	2		1	05/29/2015	2016.01	05/29/2015 12:20:20 PM Central Daylight Time		05/29/2015 10:08:54 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	356	0	2016	Florida		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:20:45 PM Central Daylight Time		05/29/2015 10:11:02 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	357	0	2016	Alabama and Tennessee		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:21:52 PM Central Daylight Time		05/29/2015 10:11:20 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	358	0	2016	Michigan		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:21:33 PM Central Daylight Time		05/29/2015 10:11:39 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	359	0	2016	Ohio		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:22:15 PM Central Daylight Time		05/29/2015 10:11:58 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	360	0	2016	Indiana and Kentucky		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:22:36 PM Central Daylight Time		05/29/2015 10:12:17 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	361	0	2016	Wisconsin		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:23:08 PM Central Daylight Time		05/29/2015 10:12:37 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	362	0	2016	Illinois		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:23:32 PM Central Daylight Time		05/29/2015 10:12:55 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	363	0	2016	Missouri		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:24:02 PM Central Daylight Time		05/29/2015 10:13:14 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	364	0	2016	Arkansas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:24:33 PM Central Daylight Time		05/29/2015 10:13:32 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	365	0	2016	Mississippi		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	2		1	05/29/2015	2016.01	05/29/2015 12:24:58 PM Central Daylight Time		05/29/2015 10:13:52 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	366	0	2016	Louisiana		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	367	0		29	10	S5921_367_0	2		1	05/29/2015	2016.01	05/29/2015 12:25:26 PM Central Daylight Time		05/29/2015 10:14:11 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	367	0	2016	Texas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:26:21 PM Central Daylight Time		05/29/2015 10:14:30 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	368	0	2016	Oklahoma		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:26:42 PM Central Daylight Time		05/29/2015 10:14:50 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	369	0	2016	Kansas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	370	0		29	10	S5921_370_0	2		1	05/29/2015	2016.01	05/29/2015 12:27:08 PM Central Daylight Time		05/29/2015 10:15:08 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	370	0	2016	IA, MN, MT, ND, NE, SD, WY		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:27:28 PM Central Daylight Time		05/29/2015 10:15:27 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	371	0	2016	New Mexico		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:27:50 PM Central Daylight Time		05/29/2015 10:15:46 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	372	0	2016	Colorado		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:28:45 PM Central Daylight Time		05/29/2015 10:16:05 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	373	0	2016	Nevada		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:29:07 PM Central Daylight Time		05/29/2015 10:16:24 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	374	0	2016	Oregon and Washington		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:29:28 PM Central Daylight Time		05/29/2015 10:16:44 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	375	0	2016	Idaho and Utah		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:29:48 PM Central Daylight Time		05/29/2015 10:17:05 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	376	0	2016	California		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:30:49 PM Central Daylight Time		05/29/2015 10:17:27 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	377	0	2016	Alaska		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	378	0		29	10	S5921_378_0	2		1	05/29/2015	2016.01	05/29/2015 12:15:55 PM Central Daylight Time		05/29/2015 10:09:07 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	378	0	2016	Maine and New Hampshire		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:16:53 PM Central Daylight Time		05/29/2015 10:09:21 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	379	0	2016	New York		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:28:21 PM Central Daylight Time		05/29/2015 10:17:47 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	380	0	2016	Arizona		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.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	05/29/2015	2016.01	05/29/2015 12:30:24 PM Central Daylight Time		05/29/2015 10:18:06 AM Central Daylight Time			06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	381	0	2016	Hawaii		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	802	0		29	10	S5921_802_0	3		1	04/14/2015	2016.01	04/14/2015 10:06:13 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	802	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5921	837	0		29	10	S5921_837_0	3		1	04/14/2015	2016.01	04/14/2015 10:06:15 AM Central Daylight Time					06/01/2015 02:44:09 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	837	0	2016	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5953	001	0		29	10	S5953_001_0	3		1	05/29/2015	2016.01	05/29/2015 03:41:44 PM Eastern Daylight Time		06/01/2015 09:15:48 AM Eastern Daylight Time			06/01/2015 03:50:24 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/rxvalue16	BlueCross Rx Value (PDP)	10	29					S5953	001	0	2016	South Carolina		2					2								www.scbluesmedadvantage.com/marx16	www.scbluesmedadvantage.com/marx16									(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(888)645-6023		(888)645-6023		(888)899-4219		(888)899-4219																
S5953	002	0		29	10	S5953_002_0	2		1	05/29/2015	2016.01	05/29/2015 11:56:22 AM Eastern Daylight Time		06/01/2015 11:25:45 AM Eastern Daylight Time			06/01/2015 12:21:55 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/rxplus16	BlueCross Rx Plus (PDP)	10	29					S5953	002	0	2016	South Carolina		2					2								www.scbluesmedadvantage.com/marx16	www.scbluesmedadvantage.com/marx16									(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(888)645-6023		(888)645-6023		(888)899-4219		(888)899-4219																
S5953	801	0		29	10	S5953_801_0	1		1	05/21/2015	2016.01	05/21/2015 03:26:31 PM Eastern Daylight Time					05/21/2015 03:41:01 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx16	Group Blue Rx Plus (PDP)	10	29					S5953	801	0	2016	South Carolina		1					2								www.scbluesmedadvantage.com/marx16	www.scbluesmedadvantage.com/marx16									(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(888)645-6023		(888)645-6023		(888)899-4219		(888)899-4219																
S5953	802	0		29	10	S5953_802_0	1		1	05/21/2015	2016.01	05/21/2015 03:24:02 PM Eastern Daylight Time					05/21/2015 03:44:52 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx16	Group Blue Rx Plus (PDP)	10	29					S5953	802	0	2016	South Carolina		1					2								www.scbluesmedadvantage.com/marx16	www.scbluesmedadvantage.com/marx16									(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(888)645-6023		(888)645-6023		(888)899-4219		(888)899-4219																
S5960	801	0		29	10	S5960_801_0	2		1	05/27/2015	2016.01	05/27/2015 03:55:57 PM Eastern Daylight Time					05/29/2015 03:06:31 PM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	www.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	801	0	2016	All States (Nationwide)		1					2								www.unicare.com/medicare	www.unicare.com/medicare									(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-																
S5960	803	0		29	10	S5960_803_0	2		1	05/27/2015	2016.01	05/27/2015 03:56:12 PM Eastern Daylight Time					05/29/2015 03:06:31 PM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	www.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	803	0	2016	All States (Nationwide)		1					2								www.unicare.com/medicare	www.unicare.com/medicare									(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-																
S5966	803	0		29	10	S5966_803_0	1		1	05/21/2015	2016.01	05/21/2015 05:07:12 PM Eastern Daylight Time					05/29/2015 03:47:22 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	803	0	2016	United States		1					2								www.emblemhealth.com	www.emblemhealth.com									(877)444-7241		(877)444-7241		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-																
S5967	138	0		29	10	S5967_138_0	5		1	05/31/2015	2016.01	05/31/2015 11:37:20 AM Eastern Daylight Time		07/14/2015 01:12:08 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	138	0	2016	Northern New England		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	139	0		29	10	S5967_139_0	5		1	05/31/2015	2016.01	05/31/2015 11:37:34 AM Eastern Daylight Time		07/14/2015 01:12:39 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	139	0	2016	Central New England		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	140	0		29	10	S5967_140_0	5		1	05/31/2015	2016.01	05/31/2015 11:37:49 AM Eastern Daylight Time		07/14/2015 01:13:09 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	140	0	2016	New York		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	141	0		29	10	S5967_141_0	5		1	05/31/2015	2016.01	05/31/2015 11:38:05 AM Eastern Daylight Time		07/14/2015 01:13:39 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	141	0	2016	New Jersey		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	142	0		29	10	S5967_142_0	5		1	05/31/2015	2016.01	05/31/2015 11:38:22 AM Eastern Daylight Time		07/14/2015 01:14:08 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	142	0	2016	Mid-Atlantic		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	143	0		29	10	S5967_143_0	5		1	05/31/2015	2016.01	05/31/2015 11:39:12 AM Eastern Daylight Time		07/14/2015 01:14:39 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	143	0	2016	Pennsylvania, West Virginia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	144	0		29	10	S5967_144_0	5		1	05/31/2015	2016.01	05/31/2015 11:39:28 AM Eastern Daylight Time		07/14/2015 01:15:09 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	144	0	2016	Virginia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	145	0		29	10	S5967_145_0	5		1	05/31/2015	2016.01	05/31/2015 11:39:46 AM Eastern Daylight Time		07/14/2015 01:15:39 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	145	0	2016	North Carolina		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	146	0		29	10	S5967_146_0	5		1	05/31/2015	2016.01	05/31/2015 11:40:03 AM Eastern Daylight Time		07/14/2015 01:16:14 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	146	0	2016	South Carolina		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	147	0		29	10	S5967_147_0	5		1	05/31/2015	2016.01	05/31/2015 11:40:20 AM Eastern Daylight Time		07/14/2015 01:16:52 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	147	0	2016	Georgia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	148	0		29	10	S5967_148_0	5		1	05/31/2015	2016.01	05/31/2015 11:40:37 AM Eastern Daylight Time		07/14/2015 01:17:22 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	148	0	2016	Florida		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	149	0		29	10	S5967_149_0	5		1	05/31/2015	2016.01	05/31/2015 11:40:58 AM Eastern Daylight Time		07/14/2015 01:17:55 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	149	0	2016	Alabama, Tennessee		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	150	0		29	10	S5967_150_0	5		1	05/31/2015	2016.01	05/31/2015 11:41:18 AM Eastern Daylight Time		07/14/2015 01:18:28 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	150	0	2016	Michigan		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	151	0		29	10	S5967_151_0	5		1	05/31/2015	2016.01	05/31/2015 11:41:38 AM Eastern Daylight Time		07/14/2015 01:19:01 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	151	0	2016	Ohio		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	152	0		29	10	S5967_152_0	5		1	05/31/2015	2016.01	05/31/2015 11:41:56 AM Eastern Daylight Time		07/14/2015 01:19:33 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	152	0	2016	Indiana, Kentucky		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	154	0		29	10	S5967_154_0	5		1	05/31/2015	2016.01	05/31/2015 11:42:12 AM Eastern Daylight Time		07/14/2015 01:20:05 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	154	0	2016	Illinois		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	155	0		29	10	S5967_155_0	5		1	05/31/2015	2016.01	05/31/2015 11:42:27 AM Eastern Daylight Time		07/14/2015 01:20:37 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	155	0	2016	Missouri		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	156	0		29	10	S5967_156_0	5		1	05/31/2015	2016.01	05/31/2015 11:42:45 AM Eastern Daylight Time		07/14/2015 01:21:08 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	156	0	2016	Arkansas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	157	0		29	10	S5967_157_0	5		1	05/31/2015	2016.01	05/31/2015 11:43:01 AM Eastern Daylight Time		07/14/2015 01:21:40 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	157	0	2016	Mississippi		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	158	0		29	10	S5967_158_0	5		1	05/31/2015	2016.01	05/31/2015 11:43:16 AM Eastern Daylight Time		07/14/2015 01:22:11 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	158	0	2016	Louisiana		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	159	0		29	10	S5967_159_0	5		1	05/31/2015	2016.01	05/31/2015 11:43:31 AM Eastern Daylight Time		07/14/2015 01:22:43 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	159	0	2016	Texas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	160	0		29	10	S5967_160_0	5		1	05/31/2015	2016.01	05/31/2015 11:43:47 AM Eastern Daylight Time		07/14/2015 01:23:13 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	160	0	2016	Oklahoma		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	161	0		29	10	S5967_161_0	5		1	05/31/2015	2016.01	05/31/2015 11:44:02 AM Eastern Daylight Time		07/14/2015 01:23:45 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	161	0	2016	Kansas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	162	0		29	10	S5967_162_0	5		1	05/31/2015	2016.01	05/31/2015 11:44:17 AM Eastern Daylight Time		07/14/2015 01:24:17 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	162	0	2016	Upper Midwest and Northern Plains		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	163	0		29	10	S5967_163_0	5		1	05/31/2015	2016.01	05/31/2015 11:44:32 AM Eastern Daylight Time		07/14/2015 01:24:49 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	163	0	2016	New Mexico		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	164	0		29	10	S5967_164_0	5		1	05/31/2015	2016.01	05/31/2015 11:44:57 AM Eastern Daylight Time		07/14/2015 01:25:21 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	164	0	2016	Colorado		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	165	0		29	10	S5967_165_0	5		1	05/31/2015	2016.01	05/31/2015 11:45:13 AM Eastern Daylight Time		07/14/2015 01:26:01 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	165	0	2016	Arizona		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	166	0		29	10	S5967_166_0	5		1	05/31/2015	2016.01	05/31/2015 11:45:31 AM Eastern Daylight Time		07/14/2015 01:26:35 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	166	0	2016	Nevada		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	167	0		29	10	S5967_167_0	5		1	05/31/2015	2016.01	05/31/2015 11:45:49 AM Eastern Daylight Time		07/14/2015 01:27:08 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	167	0	2016	Oregon, Washington		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	168	0		29	10	S5967_168_0	5		1	05/31/2015	2016.01	05/31/2015 11:46:06 AM Eastern Daylight Time		07/14/2015 01:27:40 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	168	0	2016	Idaho, Utah		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	169	0		29	10	S5967_169_0	5		1	05/31/2015	2016.01	05/31/2015 11:46:21 AM Eastern Daylight Time		07/14/2015 01:28:11 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	169	0	2016	California		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	170	0		29	10	S5967_170_0	5		1	05/31/2015	2016.01	05/31/2015 11:49:35 AM Eastern Daylight Time		07/14/2015 01:28:42 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	170	0	2016	Hawaii		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	171	0		29	10	S5967_171_0	5		1	05/31/2015	2016.01	05/31/2015 11:49:49 AM Eastern Daylight Time		07/14/2015 01:29:10 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	171	0	2016	Alaska		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	173	0		29	10	S5967_173_0	5		1	05/31/2015	2016.01	05/31/2015 11:50:28 AM Eastern Daylight Time		07/14/2015 02:04:49 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	173	0	2016	Northern New England		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	174	0		29	10	S5967_174_0	5		1	05/31/2015	2016.01	05/31/2015 11:50:45 AM Eastern Daylight Time		07/14/2015 01:32:26 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	174	0	2016	Central New England		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	175	0		29	10	S5967_175_0	5		1	05/31/2015	2016.01	05/31/2015 11:51:04 AM Eastern Daylight Time		07/14/2015 01:32:58 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	175	0	2016	New York		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	176	0		29	10	S5967_176_0	5		1	05/31/2015	2016.01	05/31/2015 11:51:19 AM Eastern Daylight Time		07/14/2015 01:33:28 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	176	0	2016	New Jersey		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	177	0		29	10	S5967_177_0	5		1	05/31/2015	2016.01	05/31/2015 11:51:34 AM Eastern Daylight Time		07/14/2015 01:33:59 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	177	0	2016	Mid-Atlantic		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	178	0		29	10	S5967_178_0	5		1	05/31/2015	2016.01	05/31/2015 11:51:50 AM Eastern Daylight Time		07/14/2015 01:34:30 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	178	0	2016	Pennsylvania, West Virginia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	179	0		29	10	S5967_179_0	5		1	05/31/2015	2016.01	05/31/2015 11:52:11 AM Eastern Daylight Time		07/14/2015 01:35:02 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	179	0	2016	Virginia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	180	0		29	10	S5967_180_0	5		1	05/31/2015	2016.01	05/31/2015 11:52:26 AM Eastern Daylight Time		07/14/2015 01:35:33 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	180	0	2016	North Carolina		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	181	0		29	10	S5967_181_0	5		1	05/31/2015	2016.01	05/31/2015 11:52:41 AM Eastern Daylight Time		07/14/2015 01:36:03 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	181	0	2016	South Carolina		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	182	0		29	10	S5967_182_0	5		1	05/31/2015	2016.01	05/31/2015 11:52:56 AM Eastern Daylight Time		07/14/2015 01:36:34 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	182	0	2016	Georgia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	183	0		29	10	S5967_183_0	5		1	05/31/2015	2016.01	05/31/2015 11:53:11 AM Eastern Daylight Time		07/14/2015 01:37:06 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	183	0	2016	Florida		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	184	0		29	10	S5967_184_0	5		1	05/31/2015	2016.01	05/31/2015 11:53:27 AM Eastern Daylight Time		07/14/2015 01:37:37 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	184	0	2016	Alabama, Tennessee		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	185	0		29	10	S5967_185_0	5		1	05/31/2015	2016.01	05/31/2015 11:53:45 AM Eastern Daylight Time		07/14/2015 01:38:07 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	185	0	2016	Michigan		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	186	0		29	10	S5967_186_0	5		1	05/31/2015	2016.01	05/31/2015 11:54:02 AM Eastern Daylight Time		07/14/2015 01:38:37 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	186	0	2016	Ohio		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	187	0		29	10	S5967_187_0	5		1	05/31/2015	2016.01	05/31/2015 11:54:21 AM Eastern Daylight Time		07/14/2015 01:39:09 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	187	0	2016	Indiana, Kentucky		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	188	0		29	10	S5967_188_0	5		1	05/31/2015	2016.01	05/31/2015 11:54:37 AM Eastern Daylight Time		07/14/2015 01:39:40 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	188	0	2016	Illinois		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	189	0		29	10	S5967_189_0	5		1	05/31/2015	2016.01	05/31/2015 11:55:28 AM Eastern Daylight Time		07/14/2015 01:40:09 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	189	0	2016	Missouri		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	190	0		29	10	S5967_190_0	5		1	05/31/2015	2016.01	05/31/2015 11:56:12 AM Eastern Daylight Time		07/14/2015 01:40:40 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	190	0	2016	Arkansas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	191	0		29	10	S5967_191_0	5		1	05/31/2015	2016.01	05/31/2015 11:56:47 AM Eastern Daylight Time		07/14/2015 01:41:12 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	191	0	2016	Mississippi		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	192	0		29	10	S5967_192_0	5		1	05/31/2015	2016.01	05/31/2015 11:57:03 AM Eastern Daylight Time		07/14/2015 01:41:42 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	192	0	2016	Louisiana		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	193	0		29	10	S5967_193_0	5		1	05/31/2015	2016.01	05/31/2015 11:57:18 AM Eastern Daylight Time		07/14/2015 01:42:13 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	193	0	2016	Texas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	194	0		29	10	S5967_194_0	5		1	05/31/2015	2016.01	05/31/2015 11:58:12 AM Eastern Daylight Time		07/14/2015 01:42:44 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	194	0	2016	Oklahoma		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	195	0		29	10	S5967_195_0	5		1	05/31/2015	2016.01	05/31/2015 11:58:29 AM Eastern Daylight Time		07/14/2015 01:43:15 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	195	0	2016	Kansas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	196	0		29	10	S5967_196_0	5		1	05/31/2015	2016.01	05/31/2015 11:58:50 AM Eastern Daylight Time		07/14/2015 01:43:45 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	196	0	2016	Upper Midwest and Northern Plains		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	197	0		29	10	S5967_197_0	5		1	05/31/2015	2016.01	05/31/2015 11:59:07 AM Eastern Daylight Time		07/14/2015 01:44:17 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	197	0	2016	New Mexico		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	198	0		29	10	S5967_198_0	5		1	05/31/2015	2016.01	05/31/2015 11:59:26 AM Eastern Daylight Time		07/14/2015 01:44:49 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	198	0	2016	Colorado		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	199	0		29	10	S5967_199_0	5		1	05/31/2015	2016.01	05/31/2015 11:59:42 AM Eastern Daylight Time		07/14/2015 01:45:20 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	199	0	2016	Arizona		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	200	0		29	10	S5967_200_0	5		1	05/31/2015	2016.01	05/31/2015 11:59:57 AM Eastern Daylight Time		07/14/2015 01:45:51 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	200	0	2016	Nevada		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	201	0		29	10	S5967_201_0	5		1	05/31/2015	2016.01	05/31/2015 12:00:11 PM Eastern Daylight Time		07/14/2015 01:46:23 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	201	0	2016	Oregon, Washington		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	202	0		29	10	S5967_202_0	5		1	05/31/2015	2016.01	05/31/2015 12:00:28 PM Eastern Daylight Time		07/14/2015 01:46:54 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	202	0	2016	Idaho, Utah		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	203	0		29	10	S5967_203_0	5		1	05/31/2015	2016.01	05/31/2015 12:00:44 PM Eastern Daylight Time		07/14/2015 01:47:26 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	203	0	2016	California		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	204	0		29	10	S5967_204_0	5		1	05/31/2015	2016.01	05/31/2015 12:00:59 PM Eastern Daylight Time		07/14/2015 01:47:57 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	204	0	2016	Hawaii		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	205	0		29	10	S5967_205_0	5		1	05/31/2015	2016.01	05/31/2015 12:01:14 PM Eastern Daylight Time		07/14/2015 01:48:28 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	205	0	2016	Alaska		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	210	0		29	10	S5967_210_0	5		1	05/31/2015	2016.01	05/31/2015 12:01:34 PM Eastern Daylight Time		07/14/2015 01:48:59 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	210	0	2016	Wisconsin		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	211	0		29	10	S5967_211_0	5		1	05/31/2015	2016.01	05/31/2015 12:01:58 PM Eastern Daylight Time		07/14/2015 01:49:30 PM Eastern Daylight Time			07/16/2015 01:51:48 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	211	0	2016	Wisconsin		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	803	0		29	10	S5967_803_0	3		1	05/30/2015	2016.01	05/30/2015 08:09:16 AM Eastern Daylight Time					06/01/2015 10:03:04 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	PDP Employer Plan1 (PDP)	10	29					S5967	803	0	2016	National		1					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5967	804	0		29	10	S5967_804_0	3		1	05/30/2015	2016.01	05/30/2015 08:09:47 AM Eastern Daylight Time					06/01/2015 10:03:04 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	PDP Employer - Plan2 (PDP)	10	29					S5967	804	0	2016	National		1					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252																
S5975	801	0		29	10	S5975_801_0	2		1	05/08/2015	2016.01	05/08/2015 12:40:43 PM Pacific Daylight Time					05/29/2015 04:48:22 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health Rx Employer Option (PDP)	10	29					S5975	801	0	2016	National		1					2								www.modahealth.com/medicare	www.modahealth.com/medicare									(888)786-7509		(503)265-4709		(888)786-7509		(503)265-4709										(711)-		(711)-		(711)-		(711)-																
S5983	004	0		29	10	S5983_004_0	2		1	05/27/2015	2016.01	05/27/2015 04:32:08 PM Eastern Daylight Time		05/29/2015 12:10:42 PM Eastern Daylight Time			05/31/2015 01:59:50 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5983	004	0	2016	State of New York		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4570		(800)758-4570		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5983	006	0		29	10	S5983_006_0	1		1	05/28/2015	2016.01	05/28/2015 06:55:42 PM Eastern Daylight Time		05/30/2015 12:02:36 PM Eastern Daylight Time			05/31/2015 02:49:39 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5983	006	0	2016	State of New York		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4570		(800)758-4570		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5983	805	0		29	10	S5983_805_0	1		1	05/30/2015	2016.01	05/30/2015 02:47:03 PM Eastern Daylight Time					05/30/2015 03:18:58 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5983	805	0	2016	National - High Performance 5 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231																
S5993	001	0		29	10	S5993_001_0	4		1	05/28/2015	2016.01	05/28/2015 03:13:09 PM Eastern Daylight Time		07/08/2015 06:13:09 AM Eastern Daylight Time			07/08/2015 06:35:29 AM Eastern Daylight Time	HORIZON HEALTHCARE SERVICES, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com/medicare	Horizon Medicare Blue Rx Standard (PDP)	10	29					S5993	001	0	2016	New Jersey		2					2								http://www.horizonblue.com/pdp-drug-search	http://www.horizonblue.com/pdp-pharmacy-search									(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142										(711)-		(711)-		(800)852-7899		(800)852-7899																
S5993	003	0		29	10	S5993_003_0	2		1	05/28/2015	2016.01	05/28/2015 03:13:47 PM Eastern Daylight Time		07/08/2015 06:14:13 AM Eastern Daylight Time			07/08/2015 06:27:02 AM Eastern Daylight Time	HORIZON HEALTHCARE SERVICES, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com/medicare	Horizon Medicare Blue Rx Enhanced (PDP)	10	29					S5993	003	0	2016	New Jersey		2					2								http://www.horizonblue.com/pdp-drug-search	http://www.horizonblue.com/pdp-pharmacy-search									(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142										(711)-		(711)-		(800)852-7899		(800)852-7899																
S5993	801	0		29	10	S5993_801_0	1		1	05/26/2015	2016.01	05/26/2015 03:33:37 PM Eastern Daylight Time					05/26/2015 05:38:32 PM Eastern Daylight Time	HORIZON HEALTHCARE SERVICES, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group Rx (PDP)	10	29					S5993	801	0	2016	National		1					2								https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en/find-medicine.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en.html									(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142										(711)-		(711)-		(800)852-7899		(800)852-7899																
S5993	804	0		29	10	S5993_804_0	1		1	05/12/2015	2016.01	05/12/2015 09:05:11 AM Eastern Daylight Time					05/15/2015 10:37:31 AM Eastern Daylight Time	HORIZON HEALTHCARE SERVICES, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group RX Plus (PDP)	10	29					S5993	804	0	2016	National		1					2								https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en/find-medicine.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en.html									(800)391-1906		(800)391-1906		(888)765-7142		(888)765-7142										(711)-		(711)-		(800)852-7899		(800)852-7899																
S6311	001	0		29	10	S6311_001_0	3		1	06/16/2015	2016.01	06/16/2015 12:50:56 PM Central Daylight Time		06/17/2015 01:23:27 PM Central Daylight Time			06/17/2015 01:39:28 PM Central Daylight Time	QUALCHOICE ADVANTAGE	QualChoice Advantage	www.qualchoiceadvantage.com	SilverSelect Rx (PDP)	10	29					S6311	001	0	2016	Arkansas		2					2								www.qualchoiceadvantage.com	www.qualchoiceadvantage.com									(844)822-7838		(844)822-7838		(844)822-7838		(844)822-7838										(711)-		(711)-		(711)-		(711)-																
S6506	001	0		29	10	S6506_001_0	2		1	05/27/2015	2016.01	05/27/2015 10:06:49 AM Central Daylight Time		05/29/2015 01:34:30 PM Central Daylight Time			05/29/2015 03:20:21 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Value (PDP)	10	29					S6506	001	0	2016	Arizona		2					2								www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com									(877)853-7693		(877)853-7693		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-																
S6506	002	0		29	10	S6506_002_0	2		1	05/27/2015	2016.01	05/27/2015 10:09:47 AM Central Daylight Time		05/29/2015 01:33:06 PM Central Daylight Time			05/29/2015 03:20:21 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Enhanced (PDP)	10	29					S6506	002	0	2016	Arizona		2					2								www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com									(877)853-7693		(877)853-7693		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-																
S6506	801	0		29	10	S6506_801_0	1		1	05/28/2015	2016.01	05/28/2015 02:27:43 PM Central Daylight Time					05/28/2015 02:40:54 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx for Groups (PDP)	10	29					S6506	801	0	2016	Nationwide		1					2								www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com									(877)560-8058		(877)560-8058		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-																
S6875	801	0		29	10	S6875_801_0	1		1	05/15/2015	2016.01	05/15/2015 11:19:12 AM Eastern Daylight Time					05/29/2015 12:49:11 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Select Option	http://www.ibxmedicare.com	Select Option Rx Group Option I CY (PDP)	10	29					S6875	801	0	2016	National		1					2							http://www.ibxmedicare.com	http://www.ibxmedicare.com	http://www.ibxmedicare.com									(888)678-7009		(888)678-7009		(866)319-5777		(866)319-5777										(711)-		(711)-		(711)-		(711)-																
S6875	802	0		29	10	S6875_802_0	1		1	04/14/2015	2016.01	04/14/2015 03:35:23 PM Eastern Daylight Time					05/29/2015 12:57:59 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Select Option	http://www.ibxmedicare.com	Select Option Rx Group Option I Non-CY (PDP)	10	29					S6875	802	0	2016	National		1					2							http://www.ibxmedicare.com	http://www.ibxmedicare.com	http://www.ibxmedicare.com									(888)678-7009		(888)678-7009		(866)319-5777		(866)319-5777										(711)-		(711)-		(711)-		(711)-																
S7230	001	0		29	10	S7230_001_0	3		1	06/02/2015	2016.01	06/02/2015 04:22:00 PM Eastern Daylight Time		05/30/2015 05:00:40 PM Eastern Daylight Time			06/08/2015 02:21:29 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Advantage-Plus Meridian	www.MedicareMeridian.com	Advantage-Plus Meridian (PDP)	10	29					S7230	001	0	2016	State of Michigan		2					2								www.MedicareMeridian.com	www.MedicareMeridian.com									(855)537-9756		(855)537-9756		(855)647-0075		(855)647-0075										(711)-		(711)-		(711)-		(711)-																
S7230	002	0		29	10	S7230_002_0	2		1	06/02/2015	2016.01	06/02/2015 04:23:04 PM Eastern Daylight Time		05/30/2015 05:10:20 PM Eastern Daylight Time			06/08/2015 02:23:28 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Advantage-Plus Meridian	www.MedicareMeridian.com	Advantage-Plus Meridian (PDP)	10	29					S7230	002	0	2016	State of Ohio		2					2								www.MedicareMeridian.com	www.MedicareMeridian.com									(855)537-9756		(855)537-9756		(855)647-0075		(855)647-0075										(711)-		(711)-		(711)-		(711)-																
S7230	003	0		29	10	S7230_003_0	2		1	06/02/2015	2016.01	06/02/2015 04:24:31 PM Eastern Daylight Time		05/30/2015 05:07:56 PM Eastern Daylight Time			06/08/2015 02:25:14 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Advantage-Plus Meridian	www.MedicareMeridian.com	Advantage-Plus Meridian (PDP)	10	29					S7230	003	0	2016	States of Indiana and Kentucky		2					2								www.MedicareMeridian.com	www.MedicareMeridian.com									(855)537-9756		(855)537-9756		(855)647-0075		(855)647-0075										(711)-		(711)-		(711)-		(711)-																
S7610	001	0		29	10	S7610_001_0	4		1	06/02/2015	2016.01	06/02/2015 04:25:39 PM Eastern Daylight Time		05/30/2015 05:08:34 PM Eastern Daylight Time			06/08/2015 02:17:06 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Advantage-Plus Meridian	www.MedicareMeridian.com	Advantage-Plus Meridian (PDP)	10	29					S7610	001	0	2016	State of Illinois		2					2								www.MedicareMeridian.com	www.MedicareMeridian.com									(855)537-9756		(855)537-9756		(855)647-0075		(855)647-0075										(711)-		(711)-		(711)-		(711)-																
S7694	001	0		29	10	S7694_001_0	4		1	05/29/2015	2016.01	05/29/2015 02:15:37 PM Eastern Daylight Time		06/30/2015 01:21:03 PM Eastern Daylight Time			07/16/2015 10:20:44 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	001	0	2016	Northern New England Region 1 Silver - ME, NH		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	002	0		29	10	S7694_002_0	4		1	05/28/2015	2016.01	05/28/2015 01:27:31 PM Eastern Daylight Time		06/30/2015 01:24:45 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	002	0	2016	Central N England EnvisionRxPlusSilver-CT/MA/RI/VT		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	003	0		29	10	S7694_003_0	4		1	05/28/2015	2016.01	05/28/2015 01:27:52 PM Eastern Daylight Time		06/30/2015 01:26:39 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	003	0	2016	New York EnvsionRxPlus Silver Region 03		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	004	0		29	10	S7694_004_0	4		1	05/29/2015	2016.01	05/29/2015 03:42:53 PM Eastern Daylight Time		06/30/2015 01:28:56 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	004	0	2016	New Jersey EnvisionRxPlus Silver Region 04		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	005	0		29	10	S7694_005_0	4		1	05/28/2015	2016.01	05/28/2015 01:31:21 PM Eastern Daylight Time		06/30/2015 01:31:07 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	005	0	2016	Mid-Atlantic EnvisionRxPlusSilverRegion05-DE/DC/MD		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	006	0		29	10	S7694_006_0	4		1	05/28/2015	2016.01	05/28/2015 02:50:38 PM Eastern Daylight Time		06/30/2015 01:33:10 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	006	0	2016	Pennsylvania, WV,EnvisionRxPlus Silver Region 06		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	007	0		29	10	S7694_007_0	4		1	05/28/2015	2016.01	05/28/2015 01:32:01 PM Eastern Daylight Time		06/30/2015 01:35:10 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	007	0	2016	Virginia EnvisionRxPlus Silver Region 07		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	008	0		29	10	S7694_008_0	4		1	05/28/2015	2016.01	05/28/2015 01:32:18 PM Eastern Daylight Time		06/30/2015 01:36:52 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	008	0	2016	North Carolina EnvisionRxPlus Silver Region 08		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	009	0		29	10	S7694_009_0	4		1	05/28/2015	2016.01	05/28/2015 01:32:38 PM Eastern Daylight Time		06/30/2015 01:38:57 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	009	0	2016	South Carolina EnvsionRxPlus Silver Region 09		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	010	0		29	10	S7694_010_0	4		1	05/28/2015	2016.01	05/28/2015 01:32:56 PM Eastern Daylight Time		06/30/2015 01:40:43 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	010	0	2016	Georgia EnvisionRxPlus Silver Region 10		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	011	0		29	10	S7694_011_0	4		1	05/28/2015	2016.01	05/28/2015 02:58:30 PM Eastern Daylight Time		06/30/2015 01:47:56 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	011	0	2016	Florida EnvisionRxPlus Silver Region 11		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	012	0		29	10	S7694_012_0	4		1	05/28/2015	2016.01	05/28/2015 01:33:32 PM Eastern Daylight Time		06/30/2015 01:50:30 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	012	0	2016	Alabama,Tennessee EnvisionRxPlus Silver Region 12		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	014	0		29	10	S7694_014_0	4		1	05/28/2015	2016.01	05/28/2015 01:33:52 PM Eastern Daylight Time		06/30/2015 01:51:57 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	014	0	2016	Ohio EnvisionRxPlus Silver Region 14		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	015	0		29	10	S7694_015_0	4		1	05/28/2015	2016.01	05/28/2015 01:34:11 PM Eastern Daylight Time		06/30/2015 01:53:42 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	015	0	2016	Indiana, Kentucky EnvisionRxPlus Silver Region 15		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	016	0		29	10	S7694_016_0	4		1	05/28/2015	2016.01	05/28/2015 01:34:28 PM Eastern Daylight Time		06/30/2015 01:55:24 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	016	0	2016	Wisconsin EnvisionRxPlus Silver Region 16		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	017	0		29	10	S7694_017_0	4		1	05/28/2015	2016.01	05/28/2015 01:34:46 PM Eastern Daylight Time		06/30/2015 01:56:55 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	017	0	2016	Illinois EnvisionRxPlus Silver Region 17		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	018	0		29	10	S7694_018_0	4		1	05/28/2015	2016.01	05/28/2015 03:37:13 PM Eastern Daylight Time		06/30/2015 01:58:59 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	018	0	2016	Missouri EnvisionRxPlus Silver Region 18		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	019	0		29	10	S7694_019_0	4		1	05/28/2015	2016.01	05/28/2015 01:35:31 PM Eastern Daylight Time		06/30/2015 02:55:14 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	019	0	2016	Arkansas EnvisionRxPlus Silver Region 19		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	020	0		29	10	S7694_020_0	4		1	05/28/2015	2016.01	05/28/2015 01:35:49 PM Eastern Daylight Time		06/30/2015 02:02:20 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	020	0	2016	Mississippi EnvisionRxPlus Silver Region 20		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	021	0		29	10	S7694_021_0	4		1	05/28/2015	2016.01	05/28/2015 01:36:05 PM Eastern Daylight Time		06/30/2015 02:04:15 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	021	0	2016	Louisiana EnvisionRxPlus Silver Region 21		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	022	0		29	10	S7694_022_0	4		1	05/28/2015	2016.01	05/28/2015 01:36:26 PM Eastern Daylight Time		06/30/2015 02:06:43 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	022	0	2016	Texas EnvisionRxPlus Silver Region 22		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	023	0		29	10	S7694_023_0	4		1	05/28/2015	2016.01	05/28/2015 01:36:48 PM Eastern Daylight Time		06/30/2015 02:08:37 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	023	0	2016	Oklahoma EnvisionRxPlus Silver Region 23		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	024	0		29	10	S7694_024_0	4		1	05/28/2015	2016.01	05/28/2015 01:37:10 PM Eastern Daylight Time		06/30/2015 02:10:10 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	024	0	2016	Kansas EnvisionRxPlus Silver Region 24		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	025	0		29	10	S7694_025_0	4		1	05/28/2015	2016.01	05/28/2015 03:10:16 PM Eastern Daylight Time		06/30/2015 02:12:11 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	025	0	2016	Midwest EnvisionRxPlus Silver IA/NE/MN/MT/ND/SD/WY		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	026	0		29	10	S7694_026_0	4		1	05/28/2015	2016.01	05/28/2015 01:37:45 PM Eastern Daylight Time		06/30/2015 02:13:46 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	026	0	2016	New Mexico EnvisionRxPlus Silver Region 26		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	027	0		29	10	S7694_027_0	4		1	05/28/2015	2016.01	05/28/2015 01:38:11 PM Eastern Daylight Time		06/30/2015 02:15:09 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	027	0	2016	Colorado EnvisionRxPlus Silver Region 27		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	028	0		29	10	S7694_028_0	4		1	05/28/2015	2016.01	05/28/2015 01:38:29 PM Eastern Daylight Time		06/30/2015 02:18:41 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	028	0	2016	Arizona EnvisionRxPlus Silver Region 28		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	029	0		29	10	S7694_029_0	4		1	05/28/2015	2016.01	05/28/2015 03:41:21 PM Eastern Daylight Time		06/30/2015 02:20:43 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	029	0	2016	Nevada EnvisionRxPlus Silver Region 29		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	030	0		29	10	S7694_030_0	4		1	05/28/2015	2016.01	05/28/2015 01:39:05 PM Eastern Daylight Time		06/30/2015 02:22:57 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	030	0	2016	Oregon, Washington EnvisionRxPlus Silver Region 30		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	031	0		29	10	S7694_031_0	4		1	05/28/2015	2016.01	05/28/2015 01:40:38 PM Eastern Daylight Time		06/30/2015 02:26:31 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	031	0	2016	Idaho, Utah EnvisionRxPlus Silver Region 31		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	032	0		29	10	S7694_032_0	4		1	05/28/2015	2016.01	05/28/2015 01:40:55 PM Eastern Daylight Time		06/30/2015 02:28:59 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	032	0	2016	California EnvisionRxPlus Silver Region 32		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	033	0		29	10	S7694_033_0	4		1	05/28/2015	2016.01	05/28/2015 01:41:14 PM Eastern Daylight Time		06/30/2015 02:31:04 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	033	0	2016	Hawaii EnvisionRxPlus Silver Region 33		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	034	0		29	10	S7694_034_0	4		1	05/28/2015	2016.01	05/28/2015 03:35:15 PM Eastern Daylight Time		06/30/2015 02:35:12 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	034	0	2016	Alaska EnvisionRxPlus Silver Region 34		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	070	0		29	10	S7694_070_0	4		1	05/28/2015	2016.01	05/28/2015 01:41:57 PM Eastern Daylight Time		06/30/2015 02:36:51 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	070	0	2016	Michigan Region 13		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	105	0		29	10	S7694_105_0	4		1	05/28/2015	2016.01	05/28/2015 04:45:33 PM Eastern Daylight Time		06/30/2015 02:40:06 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	105	0	2016	Puerto Rico (Region 38) Silver		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	106	0		29	10	S7694_106_0	4		1	05/28/2015	2016.01	05/28/2015 04:48:48 PM Eastern Daylight Time		06/30/2015 02:41:14 PM Eastern Daylight Time			07/16/2015 10:33:57 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	106	0	2016	Guam (Region 36) Silver Plan		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	107	0		29	10	S7694_107_0	2		1	05/30/2015	2016.01	05/30/2015 02:10:13 PM Eastern Daylight Time		05/29/2015 03:29:17 PM Eastern Daylight Time			05/30/2015 03:36:27 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus Clear Choice (PDP)	10	29					S7694	107	0	2016	Region 9 SC Envision Clear Choice (PBP 107)		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	115	0		29	10	S7694_115_0	4		1	08/13/2015	2016.01	08/13/2015 03:35:39 PM Eastern Daylight Time		08/13/2015 04:23:37 PM Eastern Daylight Time			08/14/2015 10:08:49 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRx Plus Clear Choice (PDP)	10	29					S7694	115	0	2016	Reg 30 OR/WA EnvisionRxPlus Clear Choice PBP115		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	117	0		29	10	S7694_117_0	2		1	05/30/2015	2016.01	05/30/2015 02:11:46 PM Eastern Daylight Time		05/29/2015 03:30:45 PM Eastern Daylight Time			05/30/2015 03:36:27 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRx Plus Clear Choice (PDP)	10	29					S7694	117	0	2016	Reg 1 ME/NH EnvisionRxPlus Clear Choice PBP117		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	118	0		29	10	S7694_118_0	4		1	08/13/2015	2016.01	08/13/2015 03:35:52 PM Eastern Daylight Time		08/13/2015 04:25:13 PM Eastern Daylight Time			08/14/2015 10:08:49 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRx Plus Clear Choice (PDP)	10	29					S7694	118	0	2016	Reg 2 CT/MA/RI/VT EnvisionRxPlus Clear Choice 118		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	119	0		29	10	S7694_119_0	4		1	08/13/2015	2016.01	08/13/2015 03:36:02 PM Eastern Daylight Time		08/13/2015 04:27:22 PM Eastern Daylight Time			08/14/2015 10:08:49 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRx Plus Clear Choice (PDP)	10	29					S7694	119	0	2016	Reg 6 PA/WV EnvisionRxPlus Clear Choice PBP119		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	120	0		29	10	S7694_120_0	4		1	08/13/2015	2016.01	08/13/2015 03:52:33 PM Eastern Daylight Time		08/13/2015 04:30:06 PM Eastern Daylight Time			08/14/2015 10:08:49 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRx Plus Clear Choice (PDP)	10	29					S7694	120	0	2016	Reg 13 MI EnvisionRxPlus Clear Choice PBP120		2					2							envision.promptpa.com	envisionrxplus.com/en/pdl.aspx#	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-																
S7694	801	0		29	10	S7694_801_0	1		1	05/27/2015	2016.01	05/27/2015 08:33:28 PM Eastern Daylight Time					05/29/2015 05:12:49 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Plan Calendar Year (PDP)	10	29					S7694	801	0	2016	National EGWP		1					2							envision.promptpa.com	EnvisionRxPlus.com	www.envisionrxplus.com/en/healthdruginfo/providerinfo.aspx									(844)293-4760		(844)293-4760		(844)293-4760		(844)293-4760										(711)-		(711)-		(711)-		(711)-																
S7694	802	0		29	10	S7694_802_0	1		1	05/27/2015	2016.01	05/27/2015 08:33:53 PM Eastern Daylight Time					05/29/2015 05:12:49 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Group Non-Calendar Year (PDP)	10	29					S7694	802	0	2016	National EGWP		1					2							envision.promptpa.com	EnvisionRxPlus.com	envisionrxplus.com/en/healthdruginfo//providerinfo.aspx									(844)293-4760		(844)293-4760		(844)293-4760		(844)293-4760										(711)-		(711)-		(711)-		(711)-																
S8067	001	0		29	10	S8067_001_0	2		1	05/31/2015	2016.01	05/31/2015 12:56:55 AM Eastern Daylight Time		05/31/2015 02:48:00 PM Eastern Daylight Time			06/01/2015 01:31:40 AM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 3 (PDP)	10	29					S8067	001	0	2016	Region 6 - Pennsylvania, West Virginia		2					2								www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com									(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	003	0		29	10	S8067_003_0	2		1	05/31/2015	2016.01	05/31/2015 12:57:02 AM Eastern Daylight Time		05/31/2015 02:50:24 PM Eastern Daylight Time			06/01/2015 01:31:40 AM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 1 (PDP)	10	29					S8067	003	0	2016	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	2		1	05/31/2015	2016.01	05/31/2015 12:57:39 AM Eastern Daylight Time					05/31/2015 01:13:14 AM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - ER (PDP)	10	29					S8067	801	0	2016	National		1					2								www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com									(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	802	0		29	10	S8067_802_0	2		1	05/31/2015	2016.01	05/31/2015 12:59:48 AM Eastern Daylight Time					05/31/2015 01:13:14 AM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - ER - Non-Calendar PY (PDP)	10	29					S8067	802	0	2016	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)-																
S8841	803	0		29	10	S8841_803_0	5		1	05/19/2015	2016.01	05/19/2015 10:32:48 AM Eastern Daylight Time					05/28/2015 02:25:09 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2016 EGWP 4-Tier Formulary CY Plan (PDP)	10	29					S8841	803	0	2016	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.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	5		1	05/19/2015	2016.01	05/19/2015 11:08:35 AM Eastern Daylight Time					05/28/2015 02:25:09 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2016 EGWP 4-Tier Formulary NCY Plan (PDP)	10	29					S8841	804	0	2016	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.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	5		1	05/19/2015	2016.01	05/19/2015 10:33:39 AM Eastern Daylight Time					05/28/2015 02:25:09 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2016 EGWP 5-Tier Formulary CY Plan (PDP)	10	29					S8841	807	0	2016	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.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	5		1	05/19/2015	2016.01	05/19/2015 10:33:54 AM Eastern Daylight Time					05/28/2015 02:25:09 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2016 EGWP 5-Tier Formulary NCY Plan (PDP)	10	29					S8841	808	0	2016	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.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	5		1	05/19/2015	2016.01	05/19/2015 10:34:08 AM Eastern Daylight Time					05/28/2015 02:25:09 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2016 MPSERS Plan (PDP)	10	29					S8841	810	0	2016	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.com									(855)577-6517		(855)577-6517		(855)577-6517		(855)577-6517										(711)-		(711)-		(711)-		(711)-																
S9579	001	0		29	10	S9579_001_0	5		1	06/01/2015	2016.01	06/01/2015 11:35:04 AM Eastern Daylight Time		05/31/2015 10:02:42 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	001	0	2016	New Hampshire and Maine		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	002	0		29	10	S9579_002_0	5		1	05/29/2015	2016.01	05/29/2015 10:14:00 PM Eastern Daylight Time		05/31/2015 10:03:18 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	002	0	2016	Connecticut, Massachusetts, Rhode Island, Vermont		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	003	0		29	10	S9579_003_0	5		1	05/29/2015	2016.01	05/29/2015 10:15:40 PM Eastern Daylight Time		05/31/2015 10:03:52 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	003	0	2016	New Jersey		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	004	0		29	10	S9579_004_0	5		1	05/29/2015	2016.01	05/29/2015 10:12:44 PM Eastern Daylight Time		05/31/2015 10:04:22 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	004	0	2016	Delaware, District of Columbia and Maryland		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	005	0		29	10	S9579_005_0	5		1	05/29/2015	2016.01	05/29/2015 10:21:09 PM Eastern Daylight Time		05/31/2015 10:20:36 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	005	0	2016	Pennsylvania and West Virginia		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	006	0		29	10	S9579_006_0	5		1	05/29/2015	2016.01	05/29/2015 10:47:56 PM Eastern Daylight Time		05/31/2015 10:07:08 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	006	0	2016	Virginia		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	007	0		29	10	S9579_007_0	5		1	05/29/2015	2016.01	05/29/2015 10:50:09 PM Eastern Daylight Time		05/31/2015 10:07:38 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	007	0	2016	North Carolina		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	008	0		29	10	S9579_008_0	5		1	05/29/2015	2016.01	05/29/2015 10:52:12 PM Eastern Daylight Time		05/31/2015 10:08:08 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	008	0	2016	South Carolina		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	009	0		29	10	S9579_009_0	5		1	05/29/2015	2016.01	05/29/2015 10:24:40 PM Eastern Daylight Time		05/31/2015 10:08:38 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	009	0	2016	Georgia		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	011	0		29	10	S9579_011_0	5		1	05/29/2015	2016.01	05/29/2015 10:25:05 PM Eastern Daylight Time		05/31/2015 10:09:08 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	011	0	2016	Alabama and Tennesee		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	012	0		29	10	S9579_012_0	5		1	05/29/2015	2016.01	05/29/2015 10:27:02 PM Eastern Daylight Time		05/31/2015 10:09:38 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	012	0	2016	Michigan		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	013	0		29	10	S9579_013_0	5		1	05/29/2015	2016.01	05/29/2015 10:27:25 PM Eastern Daylight Time		05/31/2015 10:10:08 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	013	0	2016	Ohio		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	014	0		29	10	S9579_014_0	5		1	05/29/2015	2016.01	05/29/2015 10:28:32 PM Eastern Daylight Time		05/31/2015 10:10:38 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	014	0	2016	Indiana and Kentucky		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	015	0		29	10	S9579_015_0	5		1	05/29/2015	2016.01	05/29/2015 10:28:57 PM Eastern Daylight Time		05/31/2015 10:11:08 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	015	0	2016	Wisconsin		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	016	0		29	10	S9579_016_0	5		1	05/29/2015	2016.01	05/29/2015 10:29:39 PM Eastern Daylight Time		05/31/2015 10:11:38 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	016	0	2016	Illinois		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	017	0		29	10	S9579_017_0	5		1	05/29/2015	2016.01	05/29/2015 10:31:49 PM Eastern Daylight Time		05/31/2015 10:12:06 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	017	0	2016	Missouri		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	018	0		29	10	S9579_018_0	5		1	05/29/2015	2016.01	05/29/2015 11:00:38 PM Eastern Daylight Time		05/31/2015 10:12:36 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	018	0	2016	Arkansas		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	019	0		29	10	S9579_019_0	5		1	05/29/2015	2016.01	05/29/2015 10:33:59 PM Eastern Daylight Time		05/31/2015 10:13:10 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	019	0	2016	Mississippi		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	020	0		29	10	S9579_020_0	5		1	05/29/2015	2016.01	05/29/2015 10:34:49 PM Eastern Daylight Time		05/31/2015 10:13:40 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	020	0	2016	Louisiana		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	021	0		29	10	S9579_021_0	5		1	05/29/2015	2016.01	05/29/2015 10:35:38 PM Eastern Daylight Time		05/31/2015 10:14:10 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	021	0	2016	Texas		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	022	0		29	10	S9579_022_0	5		1	05/29/2015	2016.01	05/29/2015 10:40:06 PM Eastern Daylight Time		05/31/2015 10:14:40 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	022	0	2016	Oklahoma		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	023	0		29	10	S9579_023_0	5		1	05/29/2015	2016.01	05/29/2015 10:40:47 PM Eastern Daylight Time		05/31/2015 10:15:10 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	023	0	2016	Kansas		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	024	0		29	10	S9579_024_0	5		1	05/29/2015	2016.01	05/29/2015 10:41:45 PM Eastern Daylight Time		05/31/2015 10:15:40 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	024	0	2016	IA, MN, MT, ND, NE, SD, WY		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	025	0		29	10	S9579_025_0	5		1	05/29/2015	2016.01	05/29/2015 10:43:06 PM Eastern Daylight Time		05/31/2015 10:16:10 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	025	0	2016	New Mexico		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	026	0		29	10	S9579_026_0	5		1	05/29/2015	2016.01	05/29/2015 10:43:50 PM Eastern Daylight Time		05/31/2015 10:16:40 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	026	0	2016	Colorado		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	027	0		29	10	S9579_027_0	5		1	05/29/2015	2016.01	05/29/2015 10:44:31 PM Eastern Daylight Time		05/31/2015 10:17:10 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	027	0	2016	Arizona		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	028	0		29	10	S9579_028_0	5		1	05/29/2015	2016.01	05/29/2015 10:45:06 PM Eastern Daylight Time		05/31/2015 10:17:40 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	028	0	2016	Nevada		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	029	0		29	10	S9579_029_0	5		1	05/29/2015	2016.01	05/29/2015 10:45:44 PM Eastern Daylight Time		05/31/2015 10:18:10 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	029	0	2016	Oregon and Washington		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	030	0		29	10	S9579_030_0	5		1	05/29/2015	2016.01	05/29/2015 10:46:19 PM Eastern Daylight Time		05/31/2015 10:18:40 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	030	0	2016	Idaho and Utah		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	031	0		29	10	S9579_031_0	5		1	05/29/2015	2016.01	05/29/2015 11:01:02 PM Eastern Daylight Time		05/31/2015 10:19:10 PM Eastern Daylight Time			06/01/2015 03:03:46 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	031	0	2016	California		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-																
S9579	803	0		29	10	S9579_803_0	2		1	06/02/2015	2016.01	06/02/2015 05:57:48 PM Eastern Daylight Time					06/02/2015 05:58:44 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.medicaregenerationrx.com	Medicare GenerationRx (PDP)	10	29					S9579	803	0	2016	Medicare GenerationRx		1					2								www.medicaregenerationrx.com	www.medicaregenerationrx.com									(877)633-7943		(877)633-7943		(877)633-7943		(877)633-7943										(711)-		(711)-		(711)-		(711)-																
S9579	804	0		29	10	S9579_804_0	2		1	06/02/2015	2016.01	06/02/2015 05:58:06 PM Eastern Daylight Time					06/02/2015 05:58:44 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.medicaregenerationrx.com	Medicare GenerationRx (PDP)	10	29					S9579	804	0	2016	Medicare GenerationRx		1					2								www.medicaregenerationrx.com	www.medicaregenerationrx.com									(877)633-7943		(877)633-7943		(877)633-7943		(877)633-7943										(711)-		(711)-		(711)-		(711)-																
S9579	805	0		29	10	S9579_805_0	2		1	06/02/2015	2016.01	06/02/2015 05:58:12 PM Eastern Daylight Time					06/02/2015 05:58:44 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.medicaregenerationrx.com	Medicare GenerationRx (PDP)	10	29					S9579	805	0	2016	Medicare GenerationRx		1					2								www.medicaregenerationrx.com	www.medicaregenerationrx.com									(877)633-7943		(877)633-7943		(877)633-7943		(877)633-7943										(711)-		(711)-		(711)-		(711)-																
S9579	806	0		29	10	S9579_806_0	2		1	06/02/2015	2016.01	06/02/2015 05:58:17 PM Eastern Daylight Time					06/02/2015 05:58:44 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.medicaregenerationrx.com	Medicare GenerationRx (PDP)	10	29					S9579	806	0	2016	Medicare GenerationRx		1					2								www.medicaregenerationrx.com	www.medicaregenerationrx.com									(877)633-7943		(877)633-7943		(877)633-7943		(877)633-7943										(711)-		(711)-		(711)-		(711)-																
S9701	801	0		29	10	S9701_801_0	1		1	05/20/2015	2016.01	05/20/2015 03:16:52 PM Central Daylight Time					05/29/2015 01:39:20 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	801	0	2016	Navitus MedicareRx		1					2								https://medicarerx.navitus.com/	https://medicarerx.navitus.com/									(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	802	0		29	10	S9701_802_0	1		1	05/20/2015	2016.01	05/20/2015 03:09:56 PM Central Daylight Time					05/29/2015 01:39:20 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	802	0	2016	Navitus MedicareRx		1					2								https://medicarerx.navitus.com/	https://medicarerx.navitus.com/									(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	803	0		29	10	S9701_803_0	1		1	05/20/2015	2016.01	05/20/2015 03:10:10 PM Central Daylight Time					05/29/2015 01:39:20 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	803	0	2016	Navitus MedicareRx		1					2								https://medicarerx.navitus.com/	https://medicarerx.navitus.com/									(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-																
S9701	804	0		29	10	S9701_804_0	1		1	05/20/2015	2016.01	05/20/2015 03:10:25 PM Central Daylight Time					05/29/2015 01:39:20 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	804	0	2016	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)-																
