Special Needs Plan Comprehensive Report NOTES: Data is as of November 2008 The data source for this report is the CMS Health Plan Management System. Records with enrollment between 1 and 10 (inclusive) are set to blank in order to comply with privacy law requirements. A record with fictitious contract number "Under-11" has been added for each SNP type, aggregating all records of that type with 1-10 enrollment. Employer-only group plans are omitted from this report. Aggregate Information SNP Type
Number of Contracts
Number Sub Total of Plans Enrollment
SNP Type
Chronic or Disabling Condition
107
241
275,161
Dual-Eligible
269
436
905,701
Chronic or Disabling Condition Dual-Eligible
Institutional
65
85
128,531
Institutional
Totals
Contract Number
Under - 11
441
Contract Name
Organization Type
762
1,309,393
Plan ID Segment ID
Enrollment 91
Under - 11 Totals
Plan Name
H0150
HEALTHSPRING OF ALABAMA, INC.
Local CCP
019
0
HealthSpring OptimaCare
H0154
VIVA HEALTH, INC.
Local CCP
009
0
H0302
BANNER MEDISUN, INC.
Local CCP
004
H0316
UNITEDHEALTHCARE OF ARIZONA INC Local CCP
H0319
UNITED HEALTHCARE INSURANCE COMPANY
H0319
H0351
Plan Type
Plan Geographic Name
21
90
49
62
30
243
100
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
Alabama
AL
881 Chronic or Disabling Condition
VIVA Medicare Plus Rx HMO Healthy Lifestyles
Central Alabama including Birmingham & Montgomery
AL
2,001 Chronic or Disabling Condition
0
Sun Health MediSunONE HeartSmart
HMO
MediSunONE HeartSmart, NW Maricopa County
AZ
797 Chronic or Disabling Condition
Coronary Artery Disease
013
0
Evercare Plan MH
HMO
Cochise, Graham, Santa Cruz Counties
AZ
179 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
Local CCP
004
0
Evercare Plan MP
PPO
Maricopa and Pima Counties
AZ
3,195 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Hypertension, Other
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan AD
PPO
Maricopa County
AZ
27 Chronic or Disabling Condition
HEALTH NET OF ARIZONA, INC.
Local CCP
032
0
Health Net Sage
HMO
Maricopa, Pinal, Pima, Sta Cruz, Cochise, Yavapai
AZ
1,694 Chronic or Disabling Condition
SNP_200811.xls
HMO
Number of Plans
Diabetes, Hypertension, Other
Obesity
Other
Hypercholesteremia
Page 1
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H0354
CIGNA HEALTHCARE OF ARIZONA, INC.
Local CCP
014
0
CIGNA Medicare Select HMO Plus Rx-Chronic Care
Maricopa County and City of Apache Junction
AZ
392 Chronic or Disabling Condition
H0401
UNITEDHEALTHCARE OF ARKANSAS, INC.
Local CCP
005
0
Evercare Plan MH-POS HMOPOS
Benton and Washington counties
AR
98 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H0410
UNITED HEALTHCARE INSURANCE COMPANY
Demo
003
0
Erickson Advantage Champion
Oakland and Wayne Counties
MI
220 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H0423
METROPLUS HEALTH PLAN, INC.
Local CCP
002
0
MetroPlus Partnership HMO in Care Advantage
MetroPlus Partnership in Care Advantage
NY
136 Chronic or Disabling Condition
HIV
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
133
0
Evercare Plan MH
HMO
Los Angeles
CA
1,097 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
134
0
Evercare Plan MH
HMO
Orange County
CA
512 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
135
0
Evercare Plan MH
HMO
Riverside and San Bernardino Counties
CA
1,772 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
136
0
Evercare Plan MH
HMO
Alameda, Contra Costa, San Francisco counties
CA
659 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
137
0
Evercare Plan MH-S
HMO
San Diego
CA
447 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
139
0
Evercare Plan MH
HMO
San Diego
CA
246 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Hypertension, Other
H0544
CAREMORE HEALTH PLAN
Local CCP
004
0
CareMore Reliance
HMO
Los Angeles and Orange Counties CA (partial)
6,721 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Diabetes, Hypertension, ESRD, Chronic Kidney Disease, Other
H0544
CAREMORE HEALTH PLAN
Local CCP
010
0
CareMore Reliance
HMO
San Bernardino County (partial)
837 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Diabetes, Hypertension, ESRD, Chronic Kidney Disease, Other
SNP_200811.xls
Continuing Care Retirement Community
CA
Hypercholesteremia, Diabetes, Hypertension, Other
Page 2
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H0545
INTER VALLEY HEALTH PLAN, INC.
Local CCP
009
0
Inter Valley Health Plan HMO Healthy Focus
Los Angeles and San Bernardino Counites
CA
286 Chronic or Disabling Condition
Diabetes
H0562
HEALTH NET_OF CA
Local CCP
056
0
Health Net Seniority Plus Amber
HMO
Riverside and San Bernardino Counties
CA
258 Chronic or Disabling Condition
Pulmonary Disease
H0562
HEALTH NET_OF CA
Local CCP
072
0
Health Net Healthy Heart II
HMO
LA, Orange, Riverside, San Bernardino Counties
CA
3,027 Chronic or Disabling Condition
Hypercholesteremia
H0621
COLORADO ACCESS
Local CCP
004
0
Colorado Access Advantage - Plan B
HMO
Denver Metro, El Paso County and CO San Luis Valley
105 Chronic or Disabling Condition
Other
H0621
COLORADO ACCESS
Local CCP
005
0
Colorado Access Advantage - Plan C
HMO
Denver Metro, El Paso County and CO San Luis Valley
140 Chronic or Disabling Condition
Diabetes, Other
H0624
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan MH
HMO
Denver, Colorado Springs area
CO
2,120 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H0710
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
003
0
Evercare Plan MP
PPO
Fairfld, Hrtfrd, Lthfld, New Hvn, Tollnd, Wndham
CT
2,507 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H0755
HEALTH NET OF CONNECTICUT
Local CCP
027
0
Health Net Sage
HMO
All CT Counties
CT
140 Chronic or Disabling Condition
H0838
HMO CALIFORNIA
Local CCP
020
0
Brand New Day
HMO
Counties: LA, OC, SB, Riv, Kern
CA
1,159 Chronic or Disabling Condition
H1019
CARE PLUS HEALTH PLAN
Local CCP
029
0
CareDirect Plan
HMO
Orange, Osceola, Seminole Counties
FL
44 Chronic or Disabling Condition
Diabetes
H1019
CARE PLUS HEALTH PLAN
Local CCP
030
0
CareSelect Plan
HMO
Orange, Osceola, Seminole Counties
FL
12 Chronic or Disabling Condition
Other
H1019
CARE PLUS HEALTH PLAN
Local CCP
032
0
CareDirect Plan
HMO
Broward County
FL
166 Chronic or Disabling Condition
Diabetes
H1019
CARE PLUS HEALTH PLAN
Local CCP
033
0
CareSelect Plan
HMO
Broward County
FL
189 Chronic or Disabling Condition
Other
SNP_200811.xls
Hypercholesteremia
Mental Illness
Page 3
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H1019
CARE PLUS HEALTH PLAN
Local CCP
035
0
CareDirect Plan
HMO
Dade County
FL
322 Chronic or Disabling Condition
Diabetes
H1019
CARE PLUS HEALTH PLAN
Local CCP
036
0
CareSelect Plan
HMO
Dade County
FL
498 Chronic or Disabling Condition
Other
H1019
CARE PLUS HEALTH PLAN
Local CCP
037
0
CareDirect Plan
HMO
Palm Beach County
FL
44 Chronic or Disabling Condition
Diabetes
H1019
CARE PLUS HEALTH PLAN
Local CCP
038
0
CareSelect Plan
HMO
Palm Beach County
FL
72 Chronic or Disabling Condition
Other
H1019
CARE PLUS HEALTH PLAN
Local CCP
040
0
CareDirect Plan
HMO
Hillsborough, Pasco, Pinellas Counties
FL
163 Chronic or Disabling Condition
H1019
CARE PLUS HEALTH PLAN
Local CCP
041
0
CareSelect Plan
HMO
Hillsborough, Pasco, Pinellas Counties
FL
99 Chronic or Disabling Condition
Other
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
106
0
HMO Humana Gold Plus HMO SNP-DB H1036106
Flagler, Volusia Counties
FL
206 Chronic or Disabling Condition
Other
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
108
0
Humana Gold Plus HMO HMO SNP-DB H1036108D
Baker, Duval, Nassau Counties
FL
108 Chronic or Disabling Condition
Diabetes
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
110
0
Humana Gold Plus HMO HMO SNP-DB H1036110
St. Johns, Putnam Counties
FL
46 Chronic or Disabling Condition
Diabetes
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
111
0
Humana Gold Plus HMO HMO SNP-DB H1036111C
Baker, Duval, Nassau Counties
FL
87 Chronic or Disabling Condition
Diabetes
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
115
0
Humana Gold Plus HMO HMO SNP-DB H1036115
Orlando Metro Area
FL
289 Chronic or Disabling Condition
Other
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
116
0
Humana Gold Plus HMO HMO SNP-OA H1036116
Orlando Metro Area
FL
130 Chronic or Disabling Condition
Other
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
117
0
Humana Gold Plus HMO HMO SNP-DB H1036117
Tampa Metro Area
FL
522 Chronic or Disabling Condition
Other
SNP_200811.xls
Diabetes
Page 4
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
118
0
Humana Gold Plus HMO HMO SNP-OA H1036118
Tampa Metro Area
FL
251 Chronic or Disabling Condition
Other
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
121
0
Humana Gold Plus HMO HMO SNP-DB H1036121C
Broward County
FL
301 Chronic or Disabling Condition
Diabetes
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
122
0
Humana Gold Plus HMO HMO SNP-OA H1036122C
Broward County
FL
378 Chronic or Disabling Condition
Other
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
125
0
Humana Gold Plus HMO HMO SNP-DB H1036125C
Dade County
FL
299 Chronic or Disabling Condition
Diabetes
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
126
0
HMO Humana Gold Plus HMO SNP-OA H1036126C
Dade County
FL
318 Chronic or Disabling Condition
Other
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
130
0
HMO Humana Gold Plus HMO SNP-DB H1036130C
Palm Beach County
FL
266 Chronic or Disabling Condition
Diabetes
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
131
0
Humana Gold Plus HMO HMO SNP-OA H1036131C
Palm Beach County
FL
294 Chronic or Disabling Condition
Other
H1108
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
006
0
Evercare Plan MP
Atlanta and Macon Metro Areas
GA
6,419 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H1111
UNITED HEALTHCARE OF GEORGIA, INC.
Local CCP
005
0
Evercare Plan MH-POS HMOPOS
Columbia, Harris, Muscogee, Richmond Counties
GA
588 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H1286
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
007
0
Evercare Plan MH-POS HMOPOS
Marion County
OR
113 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H1303
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
006
0
Evercare Plan MP
PPO
Ada and Canyon Counties
ID
375 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H1415
HEALTHSPRING, INC.
Local CCP
015
0
HealthSpring OptimaCare
HMO
Cook, DuPage, Kane, Lake and Will
IL
442 Chronic or Disabling Condition
Diabetes, Hypertension, Other
H1509
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan MP
PPO
Adams,Allen,Fulton,Kosciusko,St. IN Joseph,Wells
863 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
SNP_200811.xls
PPO
Page 5
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H1609
COVENTRY HEALTH CARE OF IOWA, INC.
Local CCP
004
0
Coventry AdvantraExtra HMO - Diabetes
Partial State of Iowa
IA
735 Chronic or Disabling Condition
Diabetes
H1609
COVENTRY HEALTH CARE OF IOWA, INC.
Local CCP
005
0
Coventry AdvantraExtra HMO - Cholesterol
Partial State of Iowa
IA
509 Chronic or Disabling Condition
Hypercholesteremia
H1717
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
008
0
Evercare Plan MP
PPO
Sedgwick County
KS
87 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H1717
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
010
0
Evercare Plan MP
PPO
Johnson and Wyandotte Counties KS
323 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H2003
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan MP
PPO
Cumberland, Kennebec, Sagadahoc & York Counties
ME
174 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H2111
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
011
0
Evercare Plan MP
PPO
Washington, DC
DC
573 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H2111
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
012
0
Evercare Plan MP
PPO
Kent, New Castle & Sussex, DE counties
DE
645 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H2111
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
013
0
Evercare Plan MP
PPO
Baltimore, Eastern Shore , Fairfax, MD; VA VA Areas
2,639 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H2228
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
009
0
Evercare Plan MP
PPO
Boston, Springfield and Worcester MA Metro Areas
2,892 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H2459
UCARE MINNESOTA
Local CCP
017
0
UCare Secure
HMO
Metro and Greater Minnesota Counties - 12 Counties
MN
59 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Diabetes, Dementia, Hypertension, Coronary Artery Disease, Other
H2610
ESSENCE L.L.P.
Local CCP
010
0
Essence Special Needs HMO Plan
St. Louis Metropolitan Area
IL; MO
920 Chronic or Disabling Condition
H2654
UNITED HEALTHCARE OF THE MIDWEST, INC.
Local CCP
026
0
Evercare Plan MH
HMO
St. Louis, MO, IL area
IL; MO
2,679 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H2654
UNITED HEALTHCARE OF THE MIDWEST, INC.
Local CCP
027
0
Evercare Plan MH
HMO
Springfield Area
MO
476 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
SNP_200811.xls
Diabetes
Page 6
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H2663
GROUP HEALTH PLAN, INC.
Local CCP
008
0
AdvantraExtra 1 Diabetes
HMO
St. Louis MO Metro Area
IL; MO
1,984 Chronic or Disabling Condition
Diabetes
H2663
GROUP HEALTH PLAN, INC.
Local CCP
009
0
AdvantraExtra 2 Diabetes
HMO
St. Louis MO Metro Area
IL; MO
964 Chronic or Disabling Condition
Diabetes
H2663
GROUP HEALTH PLAN, INC.
Local CCP
010
0
AdvantraExtra 3 Cholesterol
HMO
St. Louis MO Metro Area
IL; MO
780 Chronic or Disabling Condition
Hypercholesteremia
H2663
GROUP HEALTH PLAN, INC.
Local CCP
011
0
AdvantraExtra 4 Cholesterol
HMO
St. Louis MO Metro Area
IL; MO
160 Chronic or Disabling Condition
Hypercholesteremia
H2803
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
014
0
Evercare Plan MH-POS HMOPOS
Omaha, NE and Council Bluffs, IA IA; NE area
229 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H2803
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
015
0
Evercare Plan MH-POS HMOPOS
Polk, Dallas & Warren Counties
225 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H2931
HEALTH PLAN OF NEVADA, INC.
Local CCP
015
0
Sierra VillageHealth
HMO
Clark, Nye and Portions of Washoe NV County
83 Chronic or Disabling Condition
H3113
OXFORD HEALTH PLANS (NJ), INC.
Local CCP
002
0
Evercare Plan MH
HMO
Bergen,Essex,Hudson,Morris,Pass NJ aic,Somerset, Union
585 Chronic or Disabling Condition
H3132
AIDS HEALTHCARE FOUNDATION MCO Local CCP OF FLORIDA, INC.
001
0
POSITIVE HEALTHCARE PARTNERS
HMO
AHF MCO OF FLORIDA BROWARD/MIAMI-DADE COUNTIES
FL
91 Chronic or Disabling Condition
H3209
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
003
0
Evercare Plan MP
PPO
Bernalillo, Sandoval, Santa Fe & Valencia Counties
NM
137 Chronic or Disabling Condition
H3330
HIP OF GREATER NEW YORK
Local CCP
030
1
HIP VIP Chronic Care
HMO
Greater New York Metropolitan Area
NY
1,349 Chronic or Disabling Condition
Diabetes
H3330
HIP OF GREATER NEW YORK
Local CCP
030
2
HIP VIP Chronic Care
HMO
Greater New York Metropolitan Area
NY
365 Chronic or Disabling Condition
Diabetes
H3330
HIP OF GREATER NEW YORK
Local CCP
030
3
HIP VIP Chronic Care
HMO
Greater New York Metropolitan Area
NY
187 Chronic or Disabling Condition
Diabetes
SNP_200811.xls
IA
ESRD, Chronic Kidney Disease
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other HIV
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
Page 7
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H3415
DAVITA VILLAGEHEALTH, INC.
Local CCP
001
0
DaVita VillageHealth, Inc.
PPO
Jefferson County
AL
87 Chronic or Disabling Condition
H3435
UNITED HEALTHCARE INSURANCE COMPANY
Demo
003
0
Erickson Advantage Champion
Continuing Care Retirement Community
DuPage and Lake Counties
IL
144 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3456
UNITED HEALTHCARE OF NORTH CAROLINA
Local CCP
022
0
Evercare Plan MH
HMO
Select Counties in North Carolina
NC
17,740 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3528
CONNECTICARE, INC.
Local CCP
004
0
ConnectiCare VIP Custom 1
HMO
State of Connecticut
CT
558 Chronic or Disabling Condition
H3659
UNITED HEALTHCARE OF OHIO, INC.
Local CCP
059
0
Evercare Plan MH
HMO
Select Counties in Ohio
OH
5,163 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3749
PACIFICARE OF OKLAHOMA, INC.
Local CCP
014
0
Evercare Plan MH
HMO
Oklahoma City Area
OK
489 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3749
PACIFICARE OF OKLAHOMA, INC.
Local CCP
016
0
Evercare Plan MH
HMO
Creek, Rogers & Tulsa Counties
OK
173 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3812
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
007
0
Evercare Plan MP
PPO
Clackamas, Lane, Multnomah & Washington Counties
OR
1,723 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3887
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan MH-POS HMOPOS
Cook, Du Page, Kane and Lake Counties
IL
1,693 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3912
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
008
0
Evercare Plan MP
PPO
Lancaster & York Counties
PA
357 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3912
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
009
0
Evercare Plan MP
PPO
Bucks, Chester & Philadelphia Counties
PA
631 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3912
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
011
0
Evercare Plan MP
PPO
Lehigh & Northampton Counties
PA
54 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H3949
BRAVO HEALTH PENNSYLVANIA INC.
Local CCP
017
0
Bravo Healthy Heart
HMO
Philadelphia Metro Area
PA
924 Chronic or Disabling Condition
SNP_200811.xls
ESRD
Diabetes
Other
Page 8
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H3949
BRAVO HEALTH PENNSYLVANIA INC.
Local CCP
020
0
Bravo Healthy Heart
HMO
Allegheny County
PA
257 Chronic or Disabling Condition
Other
H3959
HEALTHAMERICA PENNSYLVANIA, INC. Local CCP
027
0
AdvantraExtra Cholesterol SNP
HMO
Allegheny County
PA
30 Chronic or Disabling Condition
Other
H3959
HEALTHAMERICA PENNSYLVANIA, INC. Local CCP
028
0
AdvantraExtra Cholesterol SNP
HMO
Non-Allegheny Counties
PA
62 Chronic or Disabling Condition
Other
H3959
HEALTHAMERICA PENNSYLVANIA, INC. Local CCP
029
0
AdvantraExtra Diabetes SNP
HMO
Allegheny County
PA
33 Chronic or Disabling Condition
Diabetes
H3959
HEALTHAMERICA PENNSYLVANIA, INC. Local CCP
030
0
AdvantraExtra Diabetes SNP
HMO
Non-Allegheny Counties
PA
96 Chronic or Disabling Condition
Diabetes
H4003
MMM HEALTHCARE, INC.
Local CCP
009
0
Medicare y Mucho Mßs HMO - SUPREMO
Puerto Rico
PR
28,992 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Other
H4106
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan MH
HMO
Bristol, Kent, Providence & Washington Counties
RI
1,372 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H4407
HEALTHSPRING OF TENNESSEE, INC. Local CCP
007
0
HealthSpring OptimaCare
HMO
Northern Mississippi Counties
MS
42 Chronic or Disabling Condition
Diabetes, Hypertension, Other
H4407
HEALTHSPRING OF TENNESSEE, INC. Local CCP
013
0
HealthSpring OptimaCare
HMO
South
MS
131 Chronic or Disabling Condition
Diabetes, Hypertension, Other
H4407
HEALTHSPRING OF TENNESSEE, INC. Local CCP
018
0
HealthSpring OptimaCare South
HMO
South
MS
185 Chronic or Disabling Condition
Diabetes, Hypertension, Other
H4454
HEALTHSPRING OF TENNESSEE, INC. Local CCP
018
0
HealthSpring HMO OptimaCare Preferred
Middle Tennessee
TN
469 Chronic or Disabling Condition
Diabetes, Hypertension, Other
H4454
HEALTHSPRING OF TENNESSEE, INC. Local CCP
023
0
HealthSpring OptimaCare
HMO
Middle Tennessee
TN
92 Chronic or Disabling Condition
Diabetes, Hypertension, Other
H4454
HEALTHSPRING OF TENNESSEE, INC. Local CCP
025
0
HealthSpring OptimaCare East & West
HMO
South East and West Tennessee
TN
456 Chronic or Disabling Condition
Diabetes, Hypertension, Other
SNP_200811.xls
Page 9
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H4513
TEXAS HEALTHSPRING LLC
Local CCP
019
0
Texas HealthSpring OptimaCare
HMO
Texas HealthSpring Counties
TX
2,598 Chronic or Disabling Condition
Diabetes, Hypertension, Other
H4514
EVERCARE OF TEXAS, LLC
Local CCP
004
0
Evercare Plan MH
HMO
Houston & Austin Surrounding Counties
TX
5,083 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H4522
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
008
0
Evercare Plan MP
PPO
Dona Ana, Grant, Hidalgo, Luna & NM; TX Sierra Counties
830 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H4527
PSO HEALTH SERVICES, LLC
Local CCP
008
0
Physicians Health Choice Wellness
HMO
Nueces, San Patricio and Aransas TX Counties
H4527
PSO HEALTH SERVICES, LLC
Local CCP
011
0
Physicians Health Choice Wellness
HMO
El Paso County
TX
Chronic or Disabling Condition
H4528
BRAVO HEALTH TEXAS, INC.
Local CCP
009
0
Bravo Healthy Heart
HMO
El Paso & Harris Counties
TX
2,228 Chronic or Disabling Condition
H4528
BRAVO HEALTH TEXAS, INC.
Local CCP
010
0
Bravo Healthy Heart
HMO
Bexar County
TX
463 Chronic or Disabling Condition
H4590
PACIFICARE OF TEXAS, INC.
Local CCP
035
0
Evercare Plan MH
HMO
Dallas-Fort Worth Metroplex
TX
5,917 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H4590
PACIFICARE OF TEXAS, INC.
Local CCP
036
0
Evercare Plan MH
HMO
Corpus Christi Area
TX
97 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H4590
PACIFICARE OF TEXAS, INC.
Local CCP
037
0
Evercare Plan MH
HMO
San Antonio Area
TX
1,918 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H4604
UNITED HEALTHCARE OF UTAH
Local CCP
008
0
Evercare Plan MH-POS HMOPOS
Salt Lake and Ogden Surrounding UT Counties
2,437 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H4779
UNITED HEALTHCARE INSURANCE COMPANY
Demo
003
0
Erickson Advantage Champion
Continuing Care Retirement Community
Collin and Harris Counties
TX
129 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H4912
DAVITA VILLAGEHEALTH OF MICHIGAN, INC.
Local CCP
001
0
DaVita VillageHealth, Inc.
HMOPOS
Macomb, Oakland, and Wayne counties
MI
Chronic or Disabling Condition
SNP_200811.xls
77 Chronic or Disabling Condition
Other
Diabetes
Other
Hypertension
ESRD
Page 10
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H5008
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
004
0
Evercare Plan MH
HMO
King,Kitsap,Pierce,Snohomish & Whatcom Counties
WA
2,833 Chronic or Disabling Condition
H5008
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
006
0
Evercare Plan MH
HMO
Spokane County
WA
365 Chronic or Disabling Condition
H5031
DAVITA VILLAGEHEALTH, INC.
Local CCP
001
0
DaVita VillageHealth, Inc.
PPO
District of Columbia, DC
DC
24 Chronic or Disabling Condition
H5050
GROUP HEALTH COOPERATIVE
Local CCP
012
0
Group Health Clear Care Sound
HMO
King/Pierce
WA
368 Chronic or Disabling Condition
H5253
UNITED HEALTHCARE OF WISCONSIN, Local CCP INC
027
0
Evercare Plan MH-POS HMOPOS
Appleton,GreenBay,LaCrosse,Milw WI aukee,Madison areas
H5402
QUALITY HEALTH PLANS, INC.
Local CCP
035
0
Advantage Health Florida
HMO
Florida
FL
625 Chronic or Disabling Condition
H5417
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan MP
PPO
Panhandle, Jax, Tampa & Orlando FL areas
23,695 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H5427
FREEDOM HEALTH PLAN, INC.
Local CCP
070
0
VIP Care
HMO
Florida
FL
7,297 Chronic or Disabling Condition
Diabetes, Coronary Artery Disease, Ischemic Stroke, Other
H5427
FREEDOM HEALTH PLAN, INC.
Local CCP
072
0
VIP Care+
HMO
Florida
FL
Chronic or Disabling Condition
Diabetes, Coronary Artery Disease, Ischemic Stroke, Other
H5449
DAVITA VILLAGEHEALTH, INC.
Local CCP
001
0
DaVita VillageHealth, Inc.
PPO
Northern Virginia area
VA
12 Chronic or Disabling Condition
H5509
COVENTRY HEALTH AND LIFE INS. COMPANY
Local CCP
004
0
AdvantraExtra Diabetes
PPO
Kansas City Metro Area
KS; MO
H5509
COVENTRY HEALTH AND LIFE INS. COMPANY
Local CCP
005
0
AdvantraExtra Diabetes
PPO
Wichita Metro Area
H5509
COVENTRY HEALTH AND LIFE INS. COMPANY
Local CCP
006
0
AdvantraExtra Diabetes
PPO
Southwest Missouri - Joplin
SNP_200811.xls
2,289 Chronic or Disabling Condition
Pulmonary Disease, Other
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other ESRD
Diabetes
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other Diabetes, Hypertension, Other
ESRD
1,147 Chronic or Disabling Condition
Diabetes
KS
194 Chronic or Disabling Condition
Diabetes
KS; MO
167 Chronic or Disabling Condition
Diabetes
Page 11
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H5509
COVENTRY HEALTH AND LIFE INS. COMPANY
Local CCP
007
0
AdvantraExtra Cholesterol
PPO
Kansas City Metro Area
KS; MO
886 Chronic or Disabling Condition
Hypercholesteremia
H5509
COVENTRY HEALTH AND LIFE INS. COMPANY
Local CCP
008
0
Advantra Extra Cholesterol
PPO
Wichita Metro Area
KS
116 Chronic or Disabling Condition
Hypercholesteremia
H5509
COVENTRY HEALTH AND LIFE INS. COMPANY
Local CCP
009
0
AdvantraExtra Cholesterol
PPO
Southwest Missouri - Joplin
KS; MO
138 Chronic or Disabling Condition
Hypercholesteremia
H5520
HEALTH NET LIFE INSURANCE COMPANY
Local CCP
007
0
Health Net Sage
PPO
Portland, Salem, MidVly, OR and Clark WA
OR; WA
690 Chronic or Disabling Condition
Hypercholesteremia
H5520
HEALTH NET LIFE INSURANCE COMPANY
Local CCP
008
0
Health Net Sage
PPO
Jackson and Josephine Counties, OR
OR
101 Chronic or Disabling Condition
Hypercholesteremia
H5586
SOUTH DAKOTA STATE MEDICAL HOLDING COMPANY, INC.
Local CCP
001
0
HeartLine Plus
HMO
South Dakota
SD
4,419 Chronic or Disabling Condition
Other
H5598
UNITED HEALTHCARE INSURANCE COMPANY
Demo
001
0
Evercare Plan RD
ESRD II HMOPOS
DeKalb and Fulton Counties
GA
104 Chronic or Disabling Condition
ESRD
H5652
UNITED HEALTHCARE INSURANCE COMPANY
Demo
004
0
Erickson Advantage Champion
Continuing Care Retirement Community
Baltimore, Montgomery and Prince MD Georges Counties
366 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H5665
CARE IMPROVEMENT PLUS OF MARYLAND, INC.
Local CCP
001
0
Care Improvement Plus HMO Silver Rx
Maryland
MD
585 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, ESRD, Other
H5665
CARE IMPROVEMENT PLUS OF MARYLAND, INC.
Local CCP
002
0
Care Improvement Plus HMO Gold Rx
Maryland
MD
1,420 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
H5665
CARE IMPROVEMENT PLUS OF MARYLAND, INC.
Local CCP
003
0
Care Improvement Plus HMO Platinum Rx
Maryland
MD
604 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
H5665
CARE IMPROVEMENT PLUS OF MARYLAND, INC.
Local CCP
004
0
Care Improvement Plus HMO Gold Rx Premier
Maryland
MD
119 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
H5665
CARE IMPROVEMENT PLUS OF MARYLAND, INC.
Local CCP
005
0
Care Improvement Plus HMO Gold Rx Plus
Maryland
MD
48 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
SNP_200811.xls
Page 12
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H5665
CARE IMPROVEMENT PLUS OF MARYLAND, INC.
Local CCP
006
0
Care Improvement Plus HMO Platinum Rx Plus
Maryland
MD
81 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
H5665
CARE IMPROVEMENT PLUS OF MARYLAND, INC.
Local CCP
007
0
Care Improvement Plus HMO Platinum Rx Premier
Maryland
MD
490 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
H5678
UNITED HEALTHCARE INSURANCE COMPANY
Demo
004
0
Erickson Advantage Champion
Continuing Care Retirement Community
Fairfax County
VA
48 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H5696
PHYSICIANS UNITED PLAN, INC.
Local CCP
022
0
PUP Assist
HMO
Florida
FL
20 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
H5697
UNITED HEALTHCARE INSURANCE COMPANY
Demo
003
0
Erickson Advantage Champion
Continuing Care Retirement Community
Bucks and Delaware Counties
PA
430 Chronic or Disabling Condition
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
071
0
Windsor Medicare HMO Extra Spc Care Fusion
Northwest Arkansas
AR
59 Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
072
0
Windsor Medicare HMO Extra Spc Care Fusion
Central and Northeast Arkansas
AR
18 Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
073
0
Windsor Medicare HMO Extra Spc Care Fusion
West Tennessee and North Mississippi
MS; TN
56 Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
074
0
Windsor Medicare HMO Extra Spc Care Fusion
Central Misssissippi
MS
Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
075
0
Windsor Medicare HMO Extra Spc Care Fusion
Middle Tennessee and Jefferson County Alabama
AL; TN
75 Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
076
0
Windsor Medicare HMO Extra Spc Care Fusion
East Tennessee and Greenville/Spartanburg, SC
SC; TN
85 Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
077
0
Windsor Medicare Extra Spc Care FusionPlus
HMO
Northwest Arkansas
AR
Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
078
0
Windsor Medicare Extra Spc Care FusionPlus
HMO
Central and Northeast Arkansas
AR
Chronic or Disabling Condition
Other
SNP_200811.xls
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
Page 13
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
079
0
Windsor Medicare Extra Spc Care FusionPlus
HMO
West Tennessee and North Mississippi
MS; TN
Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
080
0
Windsor Medicare Extra Spc Care FusionPlus
HMO
Central Mississippi
MS
Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
081
0
Windsor Medicare Extra Spc Care FusionPlus
HMO
Middle Tennessee and Jefferson County Alabama
AL; TN
43 Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
082
0
Windsor Medicare Extra Spc Care FusionPlus
HMO
East Tennessee and Greenville/Spartanburg, SC
SC; TN
Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
086
0
Windsor Medicare Extra Special Care COPD
HMO
Central and Northeast Arkansas
AR
Chronic or Disabling Condition
Pulmonary Disease
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
087
0
Windsor Medicare Extra Spc Care Diabetes
HMO
Central and Northeast Arkansas
AR
36 Chronic or Disabling Condition
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
088
0
Windsor Medicare Extra Special Care CHF
HMO
Central and Northeast Arkansas
AR
Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
089
0
Windsor Medicare Extra Special Care COPD
HMO
West Tennessee and North Mississippi
MS; TN
Chronic or Disabling Condition
Pulmonary Disease
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
090
0
Windsor Medicare Extra Spc Care Diabetes
HMO
West Tennessee and North Mississippi
MS; TN
80 Chronic or Disabling Condition
Diabetes
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
091
0
Windsor Medicare Extra Special Care CHF
HMO
West Tennessee and North Mississippi
MS; TN
26 Chronic or Disabling Condition
Other
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
092
0
Windsor Medicare Extra Special Care COPD
HMO
Central Mississippi
MS
24 Chronic or Disabling Condition
Pulmonary Disease
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
093
0
Windsor Medicare Extra Spc Care Diabetes
HMO
Central Mississippi
MS
89 Chronic or Disabling Condition
Diabetes
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
094
0
Windsor Medicare Extra Special Care CHF
HMO
Central Mississippi
MS
23 Chronic or Disabling Condition
Other
SNP_200811.xls
Diabetes
Page 14
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
095
0
Windsor Medicare Extra Special Care COPD
HMO
Middle Tennessee and Jefferson County Alabama
AL; TN
Chronic or Disabling Condition
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
096
0
Windsor Medicare Extra Spc Care Diabetes
HMO
Middle Tennessee and Jefferson County Alabama
AL; TN
58 Chronic or Disabling Condition
Diabetes
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
097
0
Windsor Medicare Extra Special Care CHF
HMO
Middle Tennessee and Jefferson County Alabama
AL; TN
12 Chronic or Disabling Condition
Other
H5754
UNITED HEALTHCARE INSURANCE COMPANY
Demo
004
0
Erickson Advantage Champion
Continuing Care Retirement Community
Essex and Plymouth Counties
MA
220 Chronic or Disabling Condition
H5774
AMERICAN HEALTH, INC.
Local CCP
009
0
Classic Plus
HMO
Puerto Rico
PR
2,272 Chronic or Disabling Condition
Diabetes
H5774
AMERICAN HEALTH, INC.
Local CCP
010
0
Active Plus
HMO
Puerto Rico
PR
Chronic or Disabling Condition
Diabetes
H5774
AMERICAN HEALTH, INC.
Local CCP
013
0
FreedomPlus
HMO
Puerto Rico
PR
Chronic or Disabling Condition
Diabetes
H5774
AMERICAN HEALTH, INC.
Local CCP
015
0
Opal PLUS
HMO
Puerto Rico
PR
413 Chronic or Disabling Condition
Diabetes
H5774
AMERICAN HEALTH, INC.
Local CCP
018
0
Premium Plus
HMO
Puerto Rico
PR
Chronic or Disabling Condition
Diabetes
H5821
MAPFRE LIFE INSURANCE COMPANY
Local CCP
015
0
MAPFRE Medicare Excel Extended Plus
HMOPOS
State of Puerto Rico
PR
1,000 Chronic or Disabling Condition
Other
H5821
MAPFRE LIFE INSURANCE COMPANY
Local CCP
016
0
MAPFRE Medicare Excel Premier Plus
HMOPOS
State of Puerto Rico
PR
Chronic or Disabling Condition
Other
H5852
AIDS HEALTHCARE FOUNDATION
Local CCP
001
0
POSITIVE HEALTHCARE PARTNERS
HMO
LOS ANGELES COUNTY
CA
634 Chronic or Disabling Condition
HIV
H5852
AIDS HEALTHCARE FOUNDATION
Local CCP
002
0
POSITIVE HEALTHCARE PARTNERS
HMO
LOS ANGELES COUNTY
CA
51 Chronic or Disabling Condition
HIV
SNP_200811.xls
Pulmonary Disease
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
Page 15
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H5887
FIRST MEDICAL HEALTH PLAN, INC.
Local CCP
007
0
First+Plus Complete
HMO
Entire Island Puerto Rico
PR
111 Chronic or Disabling Condition
Diabetes
H5918
UNITED HEALTHCARE INSURANCE COMPANY
Demo
004
0
Erickson Advantage Champion
Continuing Care Retirement Community
Monmouth and Morris Counties
NJ
192 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H5943
SCAN HEALTH PLAN
Demo
001
0
VillageHealth
ESRD II HMOPOS
VillageHealth
CA
413 Chronic or Disabling Condition
ESRD
H6145
DAVITA VILLAGEHEALTH, INC.
Local CCP
001
0
DaVita VillageHealth, Inc.
PPO
Clayton, DeKalb and Fulton counties
GA
32 Chronic or Disabling Condition
ESRD
H6228
UNITED HEALTHCARE INSURANCE COMPANY
Demo
003
0
Erickson Advantage Champion
Continuing Care Retirement Community
Douglas County
CO
37 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H6411
HUMANA INSURANCE COMPANY
Local CCP
005
0
PPO HumanaChoicePPO PPO SNP-OA H6411005
Dona Ana, Luna, Otero (NM), El Paso (TX)
NM; TX
Chronic or Disabling Condition
Other
H6411
HUMANA INSURANCE COMPANY
Local CCP
006
0
HumanaChoicePPO PPO PPO SNP-OA H6411006
Dona Ana, Luna, Otero (NM), El Paso (TX)
NM; TX
23 Chronic or Disabling Condition
Other
H6497
MENNONITE GENERAL HOSPITAL, INC. Local CCP
007
0
Mennonite Renal SNP HMO
Menonita Renal SNP
PR
Chronic or Disabling Condition
Other
H6497
MENNONITE GENERAL HOSPITAL, INC. Local CCP
008
0
Mennonite Mental SNP HMO
Menonita Mental SNP
PR
Chronic or Disabling Condition
Other
H6793
UNITED HEALTHCARE INSURANCE COMPANY
Demo
003
0
Erickson Advantage Champion
Johnson County
KS
47 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H7187
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
006
0
Evercare Plan MH-POS HMOPOS
Arlington County
VA
17 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H7187
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
008
0
Evercare Plan MH-POS HMOPOS
Chesterfld,Goochlnd,Hanover,Henri VA co,Richmond City
566 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
H7274
UNITED HEALTHCARE INSURANCE COMPANY
Demo
001
0
Evercare Plan RD
Pima County
SNP_200811.xls
Continuing Care Retirement Community
ESRD II HMOPOS
AZ
95 Chronic or Disabling Condition
ESRD
Page 16
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
H7526
MEDICA HEALTH PLAN
Local CCP
001
0
Medica Complete Solution
HMO
Specific Minnesota Counties
MN
51 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Hypertension, Other
H7568
DAVITA VILLAGEHEALTH, INC.
Local CCP
001
0
DaVita VillageHealth, Inc.
PPO
Hamilton County
OH
47 Chronic or Disabling Condition
ESRD
H7698
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan RD
HMOPOS
Hartford
CT
Chronic or Disabling Condition
ESRD
R3175
UNITED HEALTHCARE INSURANCE COMPANY
Regional CCP
004
0
Evercare Plan RMP
Regional PPO
State of Hawaii
HI
436 Chronic or Disabling Condition
R3444
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.
Regional CCP
001
0
Care Improvement Plus Regional PPO Silver Rx
Arkansas and Missouri
AR; MO
2,977 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, ESRD, Other
R3444
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.
Regional CCP
002
0
Care Improvement Plus Regional PPO Gold Rx
Arkansas and Missouri
AR; MO
4,652 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R3444
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.
Regional CCP
003
0
Care Improvement Plus Regional PPO Platinum Rx
Arkansas and Missouri
AR; MO
1,538 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R3444
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.
Regional CCP
004
0
Care Improvement Plus Regional PPO Gold Rx Premier
Arkansas and Missouri
AR; MO
350 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R3444
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.
Regional CCP
005
0
Care Improvement Plus Regional PPO Gold Rx Plus
Arkansas and Missouri
AR; MO
336 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R3444
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.
Regional CCP
006
0
Care Improvement Plus Regional PPO Platinum Rx Plus
Arkansas and Missouri
AR; MO
274 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R3444
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.
Regional CCP
007
0
Care Improvement Plus Regional PPO Platinum Rx Premier
Arkansas and Missouri
AR; MO
942 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R5342
UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK
Regional CCP
004
0
Evercare Plan RMP
State of New York
NY
R5826
HUMANA INSURANCE COMPANY
Regional CCP
047
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826047
States of Alabama, Tennessee
AL; TN
SNP_200811.xls
Regional PPO
1,967 Chronic or Disabling Condition 33 Chronic or Disabling Condition
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other
Pulmonary Disease, Asthma, Cardiovascular Disease, Diabetes, Dementia, Other Other
Page 17
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
R5826
HUMANA INSURANCE COMPANY
Regional CCP
048
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826048
States of Pennsylvania, West Virginia
PA; WV
28 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
049
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826049
States of North Carolina, Virginia
NC; VA
121 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
050
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826050
States of Georgia, South Carolina
GA; SC
27 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
051
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826051
State of Florida
FL
377 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
052
0
Regional PPO HumanaChoicePPO PPO SNP-OA R5826052
State of Michigan
MI
44 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
054
0
Regional PPO HumanaChoicePPO PPO SNP-OA R5826054
State of Ohio
OH
97 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
055
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826055
States of Indiana, Kentucky
IN; KY
33 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
056
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826056
States of Illinois, Wisconsin
IL; WI
52 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
057
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826057
States of Arkansas, Missouri
AR; MO
21 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
058
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826058
States of Louisiana, Mississippi
LA; MS
185 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
059
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826059
State of Texas
TX
177 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
060
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826060
States of Kansas, Oklahoma
KS; OK
33 Chronic or Disabling Condition
Other
R5826
HUMANA INSURANCE COMPANY
Regional CCP
061
0
HumanaChoicePPO Regional PPO PPO SNP-OA R5826061
State of Arizona
AZ
14 Chronic or Disabling Condition
Other
SNP_200811.xls
Page 18
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
Specialty Diseases
R6801
CARE IMPROVEMENT PLUS OF TEXAS Regional CCP INSURANCE COMPANY
001
0
Care Improvement Plus Regional PPO Silver Rx
Texas
TX
5,015 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, ESRD, Other
R6801
CARE IMPROVEMENT PLUS OF TEXAS Regional CCP INSURANCE COMPANY
002
0
Care Improvement Plus Regional PPO Gold Rx
Texas
TX
8,086 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R6801
CARE IMPROVEMENT PLUS OF TEXAS Regional CCP INSURANCE COMPANY
003
0
Care Improvement Plus Regional PPO Platinum Rx
Texas
TX
2,840 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R6801
CARE IMPROVEMENT PLUS OF TEXAS Regional CCP INSURANCE COMPANY
004
0
Care Improvement Plus Regional PPO Gold Rx Premier
Texas
TX
481 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R6801
CARE IMPROVEMENT PLUS OF TEXAS Regional CCP INSURANCE COMPANY
005
0
Care Improvement Plus Regional PPO Gold Rx Plus
Texas
TX
898 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R6801
CARE IMPROVEMENT PLUS OF TEXAS Regional CCP INSURANCE COMPANY
006
0
Care Improvement Plus Regional PPO Platinum Rx Plus
Texas
TX
637 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R6801
CARE IMPROVEMENT PLUS OF TEXAS Regional CCP INSURANCE COMPANY
007
0
Care Improvement Plus Regional PPO Platinum Rx Premier
Texas
TX
1,983 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R9896
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO
Regional CCP
001
0
Care Improvement Plus Regional PPO Silver Rx
Georgia and South Carolina
GA; SC
11,734 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, ESRD, Other
R9896
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO
Regional CCP
002
0
Care Improvement Plus Regional PPO Gold Rx
Georgia and South Carolina
GA; SC
15,073 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R9896
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO
Regional CCP
003
0
Care Improvement Plus Regional PPO Platinum Rx
Georgia and South Carolina
GA; SC
3,020 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R9896
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO
Regional CCP
004
0
Care Improvement Plus Regional PPO Gold Rx Premier
Georgia and South Carolina
GA; SC
830 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R9896
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO
Regional CCP
005
0
Care Improvement Plus Regional PPO Gold Rx Plus
Georgia and South Carolina
GA; SC
1,340 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
R9896
CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO
Regional CCP
006
0
Care Improvement Plus Regional PPO Platinum Rx Plus
Georgia and South Carolina
GA; SC
770 Chronic or Disabling Condition
Pulmonary Disease, Diabetes, Other
SNP_200811.xls
Page 19
Contract Number R9896
Contract Name CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO
Organization Type Regional CCP
Plan ID Segment ID 007
0
Plan Name
Plan Type
Care Improvement Plus Regional PPO Platinum Rx Premier
Plan Geographic Name Georgia and South Carolina
State(s) GA; SC
Under-11
Plan Enrollment
Special Needs Plan Type
1,926 Chronic or Disabling Condition
Specialty Diseases Pulmonary Disease, Diabetes, Other
91 Chronic or Disabling Condition
H0104
BLUE CROSS AND BLUE SHIELD OF ALABAMA
Local CCP
006
0
Blue Advantage Special PPO Needs Plan
State of Alabama
AL
1,361 Dual-Eligible
H0117
WELLCARE OF OHIO, INC.
Local CCP
007
0
WellCare Access
HMO
Greater Cleveland and Columbus Areas
OH
407 Dual-Eligible
H0117
WELLCARE OF OHIO, INC.
Local CCP
008
0
WellCare Select
HMO
Cuyahoga, Lake, Lorain Counties
OH
50 Dual-Eligible
H0117
WELLCARE OF OHIO, INC.
Local CCP
009
0
WellCare Select
HMO
Franklin, Hamilton, Medina, Stark, OH Summit Counties
12 Dual-Eligible
H0141
CARESOURCE MICHIGAN
Local CCP
001
0
Community Choice Advantage
HMO
SW, NE and Middle Michigan
MI
65 Dual-Eligible
H0150
HEALTHSPRING OF ALABAMA, INC.
Local CCP
007
0
HealthSpringTotalCare HMO
Alabama
AL
12,693 Dual-Eligible
H0151
UNITED HEALTHCARE OF ALABAMA, INC.
Local CCP
015
0
SecureHorizons MedicareComplete Plan 4
Central Alabama and Mobile & Baldwin Counties
AL
7,050 Dual-Eligible
H0154
VIVA HEALTH, INC.
Local CCP
010
0
VIVA Medicare Plus Rx HMO Extra Care
Central Alabama including Birmingham & Montgomery
AL
1,215 Dual-Eligible
H0245
UNISON HEALTH PLAN OF TENNESSEE, INC.
Local CCP
003
0
Unison Advantage Plus HMO
DeSoto County
MS
Dual-Eligible
H0251
UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.
Local CCP
001
0
AmeriChoice Secure Plus Complete
HMO
Tennessee
TN
6,957 Dual-Eligible
H0303
PACIFICARE OF ARIZONA, INC
Local CCP
034
0
Evercare Plan DH
HMO
Maricopa, Pima, and part of Pinal counties
AZ
4,010 Dual-Eligible
H0316
UNITEDHEALTHCARE OF ARIZONA INC Local CCP
012
0
Evercare Plan DH
HMO
Cochise, Graham and Santa Cruz AZ Counties
531 Dual-Eligible
H0319
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan DP
PPO
Maricopa County
AZ
1,455 Dual-Eligible
H0319
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
006
0
Evercare Plan DP
PPO
Pima County
AZ
1,756 Dual-Eligible
H0321
ARIZONA PHYSICIANS IPA, INC.
Local CCP
002
0
APIPA Personal Care Plus
HMO
Cochise, Maricopa, Mohave and Related Counties
AZ
15,103 Dual-Eligible
H0351
HEALTH NET OF ARIZONA, INC.
Local CCP
029
0
Health Net Amber
HMO
Maricopa, Pinal, Pima, Sta Cruz, Cochise, Yavapai
AZ
6,968 Dual-Eligible
SNP_200811.xls
HMO
Page 20
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H0354
CIGNA HEALTHCARE OF ARIZONA, INC.
Local CCP
012
0
CIGNA Medicare Select HMO Plus Rx-Dual
Maricopa County and City of Apache Junction
AZ
1,699 Dual-Eligible
H0401
UNITEDHEALTHCARE OF ARKANSAS, INC.
Local CCP
004
0
Evercare Plan DH-POS HMOPOS
Benton and Washington Counties
AR
112 Dual-Eligible
H0423
METROPLUS HEALTH PLAN, INC.
Local CCP
001
0
MetroPlus Medicare Advantage
HMO
MetroPlus Medicare Advantage
NY
900 Dual-Eligible
H0423
METROPLUS HEALTH PLAN, INC.
Local CCP
003
0
MetroPlus Advantage Select
HMO
MetroPlus Advantage Select
NY
Dual-Eligible
H0524
KAISER FOUNDATION HP, INC.
Local CCP
029
0
Senior Advantage Medicare Medi-Cal Plan
HMO
Southern California Plan
CA
28,294 Dual-Eligible
H0524
KAISER FOUNDATION HP, INC.
Local CCP
030
0
Senior Advantage Medicare Medi-Cal Plan
HMO
Northern California Plan
CA
26,508 Dual-Eligible
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
078
0
Evercare Plan DH
HMO
Los Angeles County
CA
2,985 Dual-Eligible
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
079
0
Evercare Plan DH
HMO
Orange County
CA
1,174 Dual-Eligible
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
081
0
Evercare Plan DH
HMO
Riverside and San Bernardino Counties
CA
2,295 Dual-Eligible
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
130
0
Evercare Plan DH
HMO
San Francisco, Alameda, and Contra Costa Counties
CA
550 Dual-Eligible
H0544
CAREMORE HEALTH PLAN
Local CCP
003
0
CareMore Connect
HMO
Los Angeles and Orange Counties CA (partial)
451 Dual-Eligible
H0544
CAREMORE HEALTH PLAN
Local CCP
009
0
CareMore Connect
HMO
San Bernardino County (partial)
CA
16 Dual-Eligible
H0545
INTER VALLEY HEALTH PLAN, INC.
Local CCP
008
0
Inter Valley Health Plan HMO Value Care
Los Angeles, San Bernardino and Riverside Counties
CA
69 Dual-Eligible
H0562
HEALTH NET_OF CA
Local CCP
055
0
Health Net Seniority Plus Amber I
HMO
L.A., Kern, Orange, Riverside and CA San Bernardino
1,433 Dual-Eligible
H0562
HEALTH NET_OF CA
Local CCP
070
0
Health Net Seniority Plus Amber II
HMO
Portions of So. Cal., Alameda, Contra Costa, S.F.
CA
9,325 Dual-Eligible
H0564
BLUE CROSS OF CALIFORNIA
Local CCP
040
0
Blue Cross Senior Secure Plus
HMO
Selected Counties
CA
Dual-Eligible
H0571
CHINESE COMMUNITY HEALTH PLAN
Local CCP
005
0
CCHP Senior Select Program
HMO
San Francisco County
CA
2,839 Dual-Eligible
H0621
COLORADO ACCESS
Local CCP
001
0
Colorado Access Advantage - Plan D
HMO
Denver Metro, El Paso County and CO San Luis Valley
2,387 Dual-Eligible
H0624
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan DH
HMO
Denver, Colorado Springs area
2,690 Dual-Eligible
SNP_200811.xls
CO
Specialty Diseases
Page 21
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H0630
KAISER FOUNDATION HP OF CO
Local CCP
014
0
Senior Advantage Medicare Medicaid Plan
HMO
Denver Metropolitan Area
CO
2,080 Dual-Eligible
H0710
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan DP
PPO
Fairfld, Hrtfrd, Lthfld, New Hvn, Tollnd, Wndham
CT
1,857 Dual-Eligible
H0712
WELLCARE OF CONNECTICUT, INC.
Local CCP
005
0
WellCare Access
HMO
Fairfield, Hartford, Tollandand New CT Haven Counties
1,330 Dual-Eligible
H0712
WELLCARE OF CONNECTICUT, INC.
Local CCP
011
0
WellCare Select
HMOPOS
Fairfield, Hartford, Tolland andNew CT Haven Counties
171 Dual-Eligible
H0755
HEALTH NET OF CONNECTICUT
Local CCP
021
0
Health Net Amber
HMO
Connecticut
CT
944 Dual-Eligible
H0901
AETNA HEALTH INC.
Local CCP
005
0
Aetna Golden Medicare HMO Dual Advantage Plan
District of Columbia
DC
91 Dual-Eligible
H0908
BUCKEYE COMMUNITY HEALTH PLAN, Local CCP INC.
001
0
Buckeye Community Health Plan
HMO
Buckeye Community Health Plan
OH
96 Dual-Eligible
H0913
WELLCARE HEALTH PLANS OF NEW JERSEY, INC.
Local CCP
003
0
WellCare Access
HMO
Essex, Hudson, Passaic, Union, Middlesex Counties
NJ
480 Dual-Eligible
H0913
WELLCARE HEALTH PLANS OF NEW JERSEY, INC.
Local CCP
004
0
WellCare Select
HMO
Essex, Hudson, Passaic, Union Counties
NJ
Dual-Eligible
H0913
WELLCARE HEALTH PLANS OF NEW JERSEY, INC.
Local CCP
005
0
WellCare Select
HMO
Middlesex County
NJ
Dual-Eligible
H0974
HMO MINNESOTA D/B/A BLUE PLUS
Local CCP
001
0
CareBlue
HMO
78 Counties within the State of Minnesota
MN
732 Dual-Eligible
H1013
VISTA HEALTHPLAN OF SOUTH FLORIDA, INC.
Local CCP
024
0
VISTA Platinum Choice HMO Plan
Dade, Broward, Martin and St. Lucie Counties
FL
576 Dual-Eligible
H1019
CARE PLUS HEALTH PLAN
Local CCP
023
0
CareNeeds Plan
HMO
Broward County
FL
1,494 Dual-Eligible
H1019
CARE PLUS HEALTH PLAN
Local CCP
024
0
CareNeeds Plan
HMO
Dade County
FL
5,260 Dual-Eligible
H1019
CARE PLUS HEALTH PLAN
Local CCP
025
0
CareNeeds Plan
HMO
Palm Beach County
FL
499 Dual-Eligible
H1019
CARE PLUS HEALTH PLAN
Local CCP
026
0
CareNeeds Plan
HMO
Hillsborough, Pasco and Pinellas Counties
FL
1,075 Dual-Eligible
H1019
CARE PLUS HEALTH PLAN
Local CCP
028
0
CareNeeds Plan
HMO
Orange, Osceola, Seminole Counties
FL
539 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
060
0
WellCare Select
HMOPOS
Palm Beach, St. Lucie, and Okeechobee Counties
FL
460 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
061
0
WellCare Select
HMOPOS
Orange, Seminole, and Osceola Counties
FL
1,482 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
064
0
WellCare Select
HMOPOS
Pinellas County
FL
357 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
065
0
WellCare Select
HMOPOS
Hillsborough County
FL
347 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
066
0
WellCare Select
HMOPOS
Broward County
FL
206 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
085
0
WellCare Access
HMO
Hillsborough County
FL
1,430 Dual-Eligible
SNP_200811.xls
Specialty Diseases
Page 22
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
086
0
WellCare Access
HMO
Pinellas County
FL
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
088
0
WellCare Access
HMO
Broward County
FL
282 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
089
0
WellCare Access
HMO
Palm Beach, St Lucie, and Okeechobee Counties
FL
706 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
101
0
WellCare Select
HMOPOS
Clay and Duval Counties
FL
243 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
102
0
WellCare Select
HMOPOS
Brevard County
FL
454 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
104
0
WellCare Select
HMOPOS
Charlotte, Sarasota, and Manatee FL Counties
100 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
106
0
WellCare Select
HMOPOS
Polk County
FL
494 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
107
0
WellCare Select
HMOPOS
Miami - Dade County
FL
887 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
122
0
Wellcare Access
HMO
Brevard and Indian River Counties FL
461 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
123
0
WellCare Access
HMO
Clay and Duval Counties
FL
634 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
124
0
WellCare Access
HMO
Orange, Seminole, and Osceola Counties
FL
2,110 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
125
0
WellCare Access
HMO
Escambia, Santa Rosa, Okaloosa, FL et al
929 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
126
0
WellCare Select
HMOPOS
Escambia, Santa Rosa, and Okaloosa Counties
FL
112 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
127
0
WellCare Access
HMO
Hernando County
FL
209 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
128
0
WellCare Access
HMO
Manatee, Sarasota, and Charlotte FL Counties
220 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
130
0
WellCare Access
HMO
Polk County
FL
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
136
0
WellCare Select
HMOPOS
Pasco County
FL
269 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
138
0
WellCare Access
HMO
Pasco County
FL
475 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
148
0
WellCare Access
HMO
Lake and Marion Counties
FL
220 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
152
0
WellCare Select
HMOPOS
Lake and Marion Counties
FL
32 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
153
0
WellCare Select
HMOPOS
Calhoun, Gadsden, Jefferson, Liberty, et. al.
FL
42 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
161
0
WellCare Select Plus
HMOPOS
Dade County
FL
269 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
162
0
WellCare Select
HMOPOS
Hernando County
FL
12 Dual-Eligible
H1032
WELL CARE OF FLORIDA, INC.
Local CCP
163
0
WellCare Access
HMO
Dade County
FL
208 Dual-Eligible
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
077
0
Humana Gold Plus HMO HMO SNP-DE H1036077A
Dade County
FL
3,103 Dual-Eligible
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
102
0
Humana Gold Plus HMO HMO SNP-DE H1036102
Tampa Metro Area
FL
1,522 Dual-Eligible
SNP_200811.xls
Specialty Diseases
800 Dual-Eligible
1,042 Dual-Eligible
Page 23
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
103
0
Humana Gold Plus HMO HMO SNP-DE H1036103A
Broward County
FL
1,549 Dual-Eligible
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
104
0
Humana Gold Plus HMO HMO SNP-DE H1036104A
Palm Beach County
FL
979 Dual-Eligible
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
105
0
Humana Gold Plus HMO HMO SNP-DE H1036105
Flagler, Volusia Counties
FL
912 Dual-Eligible
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
109
0
Humana Gold Plus HMO HMO SNP-DE H1036109C
Baker, Duval, Nassau Counties
FL
604 Dual-Eligible
H1036
HUMANA MEDICAL PLAN, INC
Local CCP
114
0
HMO Humana Gold Plus HMO SNP-DE H1036114
Orlando Metro Area
FL
1,222 Dual-Eligible
H1045
PREFERRED CARE PARTNERS INC.
Local CCP
012
0
Preferred Care Partners Medicare Assist
Miami-Dade and Broward Counties FL
40 Dual-Eligible
H1076
VISTA HEALTHPLAN, INC.
Local CCP
011
0
VISTA Platinum Choice HMO Plan
Dade, Broward and Palm Beach Counties
FL
1,482 Dual-Eligible
H1080
UNITED HEALTHCARE OF FL, INC.
Local CCP
036
0
Evercare Plan DH
HMO
Tampa area Counties
FL
455 Dual-Eligible
H1099
HEALTH FIRST HEALTH PLANS, INC.
Local CCP
008
0
Health First Sunshine Plan
HMO
All Brevard & Indian River Zips 32957/32958/32978
FL
377 Dual-Eligible
H1108
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan DP
PPO
Atlanta and Macon Metro Areas
GA
2,656 Dual-Eligible
H1111
UNITED HEALTHCARE OF GEORGIA, INC.
Local CCP
004
0
Evercare Plan DH-POS HMOPOS
Columbia, Harris, Muscogee and Richmond Counties
GA
406 Dual-Eligible
H1112
WELLCARE OF GEORGIA, INC.
Local CCP
005
0
WellCare Select
HMO
DeKalb, Fulton, Gwinnett, et al
GA
312 Dual-Eligible
H1112
WELLCARE OF GEORGIA, INC.
Local CCP
006
0
WellCare Access
HMO
DeKalb, Fulton, Gwinnett, et al
GA
1,251 Dual-Eligible
H1170
KAISER FOUNDATION HP OF GA, INC. Local CCP
008
0
Senior Advantage Medicare Medicaid Plan
HMO
Atlanta Metro Area
GA
939 Dual-Eligible
H1216
HARMONY HEALTH PLAN OF ILLINOIS, Local CCP INC.
003
0
WellCare Access
HMO
St. Charles, St. Louis, St. Louis City MO Counties
761 Dual-Eligible
H1216
HARMONY HEALTH PLAN OF ILLINOIS, Local CCP INC.
004
0
WellCare Select
HMOPOS
St. Charles, St. Louis, St. Louis City MO Counties
28 Dual-Eligible
H1264
WELLCARE OF TEXAS, INC.
006
0
WellCare Access
HMO
Harris County
SNP_200811.xls
Local CCP
HMO
TX
Specialty Diseases
571 Dual-Eligible
Page 24
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
H1264
WELLCARE OF TEXAS, INC.
Local CCP
007
0
WellCare Access
HMO
Bexar, Dallas, Tarrant Counties
H1264
WELLCARE OF TEXAS, INC.
Local CCP
009
0
WellCare Select
HMOPOS
H1264
WELLCARE OF TEXAS, INC.
Local CCP
010
0
WellCare Select
HMOPOS
H1264
WELLCARE OF TEXAS, INC.
Local CCP
011
0
WellCare Select
HMOPOS
H1286
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
006
0
H1303
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
004
H1350
BLUE CROSS OF IDAHO HEALTH SERVICES, INC
Local CCP
H1364
UNISON HEALTH PLAN OF OHIO, INC.
H1406
State(s)
Plan Enrollment
Special Needs Plan Type
TX
623 Dual-Eligible
Harris County
TX
129 Dual-Eligible
Dallas, Tarrant Counties
TX
24 Dual-Eligible
Bexar County
TX
67 Dual-Eligible
Evercare Plan DH-POS HMOPOS
Marion County
OR
Dual-Eligible
0
Evercare Plan DP
PPO
Ada and Canyon Counties
ID
738 Dual-Eligible
009
0
True Blue Special Needs Plan
HMO
Select Counties in Idaho
ID
716 Dual-Eligible
Local CCP
003
0
Unison Advantage Plus HMO
Holmes and Wayne counties
OH
HUMANA HEALTH PLAN, INC.
Local CCP
024
0
HMO Humana Gold Plus HMO SNP-DE H1406024F
Cook County
IL
107 Dual-Eligible
H1415
HEALTHSPRING, INC.
Local CCP
005
0
HealthSpring TotalCare HMO
Cook, DuPage, Kane, Lake and Will
IL
2,410 Dual-Eligible
H1416
HARMONY HEALTH PLAN OF ILLINOIS, Local CCP INC.
003
0
WellCare Select
HMOPOS
Cook and Will Counties
IL
290 Dual-Eligible
H1416
HARMONY HEALTH PLAN OF ILLINOIS, Local CCP INC.
007
0
WellCare Access
HMO
Cook, Will, Champaign, Douglas, et IL al
3,357 Dual-Eligible
H1416
HARMONY HEALTH PLAN OF ILLINOIS, Local CCP INC.
013
0
WellCare Select
HMOPOS
Champaign, Douglas, and Vermilion Counties
IL
Dual-Eligible
H1416
HARMONY HEALTH PLAN OF ILLINOIS, Local CCP INC.
017
0
WellCare Select
HMOPOS
Madison and St. Clair Counties
IL
Dual-Eligible
H1419
AETNA HEALTH OF ILLINOIS, INC.
Local CCP
005
0
Aetna Golden Medicare HMO Dual Advantage Plan
Cook County
IL
100 Dual-Eligible
H1509
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
004
0
Evercare Plan DP
Indianapolis, Fort Wayne, South Bend areas
IN
1,139 Dual-Eligible
H1609
COVENTRY HEALTH CARE OF IOWA, INC.
Local CCP
006
0
Coventry AdvantraOne HMO
Partial State of Iowa
IA
282 Dual-Eligible
H1657
HARMONY HEALTH PLANS OF ILLINOIS, INC.
Local CCP
004
0
WellCare Access
HMO
St. Joseph, Kosciusko, Allen, et al IN
323 Dual-Eligible
H1657
HARMONY HEALTH PLANS OF ILLINOIS, INC.
Local CCP
005
0
WellCare Select
HMOPOS
St. Joseph, Kosciusko, Allen Counties
IN
Dual-Eligible
H1657
HARMONY HEALTH PLANS OF ILLINOIS, INC.
Local CCP
006
0
WellCare Select
HMOPOS
Johnson, Marion Counties
IN
23 Dual-Eligible
H1657
HARMONY HEALTH PLANS OF ILLINOIS, INC.
Local CCP
007
0
WellCare Select
HMOPOS
Lake County
IN
Dual-Eligible
SNP_200811.xls
PPO
Specialty Diseases
Dual-Eligible
Page 25
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H1717
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
006
0
Evercare Plan DP
PPO
Sedgwick County
KS
84 Dual-Eligible
H1717
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
007
0
Evercare Plan DP
PPO
Johnson and Wyandotte Counties KS
65 Dual-Eligible
H1807
UNIVERSITY HEALTH CARE, INC.
Local CCP
001
0
Passport Advantage
HMO
Louisville Metro Area and 15 surrounding counties
KY
9,505 Dual-Eligible
H1903
WELLCARE OF LOUISIANA, INC.
Local CCP
011
0
WellCare Access
HMO
Greater Baton Rouge Area
LA
870 Dual-Eligible
H1903
WELLCARE OF LOUISIANA, INC.
Local CCP
014
0
WellCare Select
HMOPOS
Greater Baton Rouge Area
LA
201 Dual-Eligible
H1951
HUMANA HEALTH BENEFIT PLAN OF LOUISIANA INC
Local CCP
017
0
Humana Gold Plus HMO HMO SNP-DE H1951017
New Orleans Metro Area
LA
442 Dual-Eligible
H1951
HUMANA HEALTH BENEFIT PLAN OF LOUISIANA INC
Local CCP
019
0
HMO Humana Gold Plus HMO SNP-DE H1951019
Baton Rouge Metro Area
LA
494 Dual-Eligible
H1951
HUMANA HEALTH BENEFIT PLAN OF LOUISIANA INC
Local CCP
021
0
HMO Humana Gold Plus HMO SNP-DE H1951021
Bossier, Caddo, Webster
LA
260 Dual-Eligible
H1961
TENET CHOICES, INC. / PEOPLES HEALTH NETWORK
Local CCP
003
0
Secure Health
HMO
New Orleans Metro and Southeast LA Louisiana
1,601 Dual-Eligible
H2001
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
007
0
Evercare Plan DP
PPO
Cumberland, Kennebec, Sagadahoc & York Counties
ME
30 Dual-Eligible
H2034
COMMUNITY CARE HEALTH PLAN, INC. Local CCP
001
0
Community Care's Partnership Program
HMO
Ken, Milw, Ozaukee, Rac, Wash, Wauk Counties
WI
Dual-Eligible
H2034
COMMUNITY CARE HEALTH PLAN, INC. Local CCP
002
0
Community Care WPP HMO Disabled
Ken, Milw, Ozaukee, Rac, Wash, Wauk Counties
WI
Dual-Eligible
H2108
BRAVO HEALTH MID- ATLANTIC INC.
Local CCP
001
0
Bravo Select
HMO
Baltimore and District of Columbia DC; MD Metro Areas
H2111
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
008
0
Evercare Plan DP
PPO
Washington, DC
DC
469 Dual-Eligible
H2111
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
009
0
Evercare Plan DP
PPO
Kent, New Castle, Sussex
DE
269 Dual-Eligible
H2111
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
010
0
Evercare Plan DP
PPO
Baltimore, Eastern Shore & Fairfax, MD; VA VA area
473 Dual-Eligible
H2112
AETNA HEALTH INC. (MARYLAND)
Local CCP
013
0
Aetna Golden Medicare HMO Dual Advantage Plan
Baltimore and Surrounding Counties
MD
368 Dual-Eligible
H2174
TRILLIUM COMMUNITY HEALTH PLAN
Local CCP
001
0
Trillium Advantage Dual HMO SNP
Lane , Jackson counties
OR
2,210 Dual-Eligible
H2224
SENIOR WHOLE HEALTH, LLC
Local CCP
001
0
Senior Whole Health
Brstl, Essx, Midlsex, Nrfolk, Plymth, MA Sufolk, Worc
4,555 Dual-Eligible
SNP_200811.xls
HMO
Specialty Diseases
4,249 Dual-Eligible
Page 26
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H2225
COMMONWEALTH CARE ALLIANCE, INC.
Local CCP
001
0
Senior Care Options Program
HMO
Greater Boston, Springfield, Merrimack Valley
MA
1,690 Dual-Eligible
H2226
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Senior Care Options
HMO
Boston, Springfield and Worcester MA Metro Areas
3,205 Dual-Eligible
H2228
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
004
0
Evercare Plan DP
PPO
Boston, Springfield and Worcester MA Metro Areas
3,073 Dual-Eligible
H2237
INDEPENDENT CARE HEALTH PLAN, INC.
Local CCP
001
0
iCare Medicare Plan
HMO
iCare Milwaukee County Medicare WI Plan
2,634 Dual-Eligible
H2237
INDEPENDENT CARE HEALTH PLAN, INC.
Local CCP
002
0
iCare Medicare Plan
HMO
iCare SE Wisconsin Medicare Plan WI
22 Dual-Eligible
H2291
PROSALUD HMO, CORP.
Local CCP
003
0
ProSalud Medicare Especial
HMO
Commonwealth of Puerto Rico
PR
Dual-Eligible
H2407
UCARE MINNESOTA
Local CCP
001
0
UCare Complete
HMO
Minneapolis, St. Paul, and Surrounding Metro
MN
604 Dual-Eligible
H2407
UCARE MINNESOTA
Local CCP
002
0
Partners Choice Network
HMO
Scott, Carver, and Hennepin counties
MN
32 Dual-Eligible
H2416
PRIMEWEST HEALTH SYSTEM
Local CCP
001
0
PrimeWest Senior Health Complete
HMO
West Central and Southwest Minnesota
MN
2,126 Dual-Eligible
H2417
ITASCA MEDICAL CARE
Local CCP
001
0
IMCare Classic
HMO
Itasca, N. Aitkin and S. Koochiching MN Counties
468 Dual-Eligible
H2419
SOUTH COUNTRY HEALTH ALLIANCE
Local CCP
001
0
SeniorCare Complete
HMO
Select Counties in Minnesota
MN
1,914 Dual-Eligible
H2422
GROUP HEALTH, INC.
Local CCP
002
0
Classic Minnesota HMO Senior Health Options
Twin Cities Metropolitian Area
MN
2,654 Dual-Eligible
H2424
FIRST PLAN OF MINNESOTA
Local CCP
001
0
FirstPlan Blue - MSHO HMO
Northeastern Minnesota
MN
1,003 Dual-Eligible
H2425
BLUE PLUS
Local CCP
001
0
SecureBlue
HMO
56 Counties within the State of Minnesota
MN
10,060 Dual-Eligible
H2456
UCARE MINNESOTA
Local CCP
002
0
Minnesota Senior Health Options
HMO
Minneapolis, St. Paul, and Greater MN Minnesota Area
7,982 Dual-Eligible
H2457
METROPOLITAN HEALTH PLAN
Local CCP
002
0
MHP-MSHO
HMO
Minnesota
MN
741 Dual-Eligible
H2458
MEDICA HEALTH PLANS
Local CCP
002
0
Medica Dual Solution
HMO
Specific Minnesota Counties
MN
8,379 Dual-Eligible
H2459
UCARE MINNESOTA
Local CCP
016
0
UCare Connect
HMO
Greater Minnesota Area
MN
42 Dual-Eligible
H2643
L. A. CARE HEALTH PLAN
Local CCP
001
0
L.A. Care
HMO
Los Angeles County
CA
67 Dual-Eligible
H2649
HUMANA HEALTH PLAN, INC.
Local CCP
015
0
HMO Humana Gold Plus HMO SNP-DE H2649015
Jackson
MO
240 Dual-Eligible
H2654
UNITED HEALTHCARE OF THE MIDWEST, INC.
Local CCP
023
0
Evercare Plan DH
Springfield Area
MO
239 Dual-Eligible
SNP_200811.xls
HMO
Specialty Diseases
Page 27
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
H2654
UNITED HEALTHCARE OF THE MIDWEST, INC.
Local CCP
024
0
Evercare Plan DH
H2803
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
010
0
H2803
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
012
H2899
ARCADIAN HEALTH PLAN OF NORTH CAROLINA, INC.
Local CCP
H2926
PRIMEWEST HEALTH SYSTEM
Plan Type
St. Louis, MO, IL area
State(s)
Special Needs Plan Type
IL; MO
1,575 Dual-Eligible
Evercare Plan DH-POS HMOPOS
Omaha, NE and Council Bluffs, IA IA; NE area
248 Dual-Eligible
0
Evercare Plan DH-POS HMOPOS
Polk, Dallas & Warren Counties
IA
109 Dual-Eligible
002
0
Southeast Community HMO Care - Dual Plus
Eastern North Carolina
NC
725 Dual-Eligible
Local CCP
001
0
Prime Health Complete HMO
West Central and Southwest Minnesota
MN
143 Dual-Eligible
H3059
PHYSICIANS HEALTH CHOICE OF NEW Local CCP MEXICO
004
0
Physicians Health Choice Select
HMO
Dona Ana and Otero Counties
NM
198 Dual-Eligible
H3112
AMERIHEALTH HMO_INC
Local CCP
001
0
AmeriHealth 65 Basic
HMO
Berks,Lancaster,Lehigh, Northampton,York Counties
PA
4,319 Dual-Eligible
H3113
OXFORD HEALTH PLANS (NJ), INC.
Local CCP
003
0
Evercare Plan DH
HMO
Bergen,Essex,Hudson,Morris,Pass NJ aic,Somerset, Union
122 Dual-Eligible
H3152
AETNA HEALTH, INC.
Local CCP
073
0
Aetna Golden Medicare HMO Dual Advantage Plan
Burlington, Camden, Gloucester and Mercer Counties
NJ
253 Dual-Eligible
H3152
AETNA HEALTH, INC.
Local CCP
074
0
Aetna Golden Medicare HMO Dual Advantage Plan
Northern New Jersey
NJ
498 Dual-Eligible
H3154
HORIZON HEALTHCARE OF NEW JERSEY, INC.
Local CCP
014
0
Horizon Medicare Blue HMO Solutions
New Jersey
NJ
257 Dual-Eligible
H3164
AMERICHOICE OF NEW JERSEY, INC
Local CCP
003
0
AmeriChoice Personal HMO Care Plus
Northern, Central, and Southern New Jersey
NJ
2,444 Dual-Eligible
H3209
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan DP
PPO
Bernalillo, Sandoval, Santa Fe & Valencia Counties
NM
385 Dual-Eligible
H3240
AMERIGROUP NEW JERSEY, INC.
Local CCP
013
0
AMERIVANTAGE Specialty + Rx
HMO
Eastern/Central New Jersey
NJ
513 Dual-Eligible
H3307
OXFORD HEALTH PLANS (NY) INC.
Local CCP
020
0
Evercare Plan DH
HMO
Bronx, Kings, New York, Queens & NY Richmond Counties
1,512 Dual-Eligible
H3327
TOUCHSTONE HEALTH HMO, INC.
Local CCP
026
0
Touchstone Health Medicare Prestige
PSO (State License)
SNP - NYC
NY
695 Dual-Eligible
H3327
TOUCHSTONE HEALTH HMO, INC.
Local CCP
027
0
Touchstone Health Medicare Prestige
PSO (State License)
SNP - Upstate
NY
34 Dual-Eligible
H3327
TOUCHSTONE HEALTH HMO, INC.
Local CCP
029
0
Touchstone Health PSO (State Medicare Lunar Plan 2 License)
SNP - NYC
NY
176 Dual-Eligible
SNP_200811.xls
HMO
Plan Geographic Name
Plan Enrollment
Specialty Diseases
Page 28
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
H3327
TOUCHSTONE HEALTH HMO, INC.
Local CCP
030
0
Touchstone Health Medicare Prestige
H3328
NEW YORK STATE CATHOLIC HLTH PLAN INC
Local CCP
002
0
H3328
NEW YORK STATE CATHOLIC HLTH PLAN INC
Local CCP
013
H3330
HIP OF GREATER NEW YORK
Local CCP
H3330
HIP OF GREATER NEW YORK
H3330
HIP OF GREATER NEW YORK
Plan Type
State(s)
Special Needs Plan Type
SNP - Northern Metro
NY
Dual-Eligible
Fidelis Dual Advantage HMO
NY Counties
NY
235 Dual-Eligible
0
Fidelis Dual Advantage HMO Flex Plan
NY Counties
NY
234 Dual-Eligible
029
0
HIP VIP Dual Eligible
HMO
Greater New York Metropolitan Area
NY
5,274 Dual-Eligible
Local CCP
031
2
HIP VIP Medicaid Advantage
HMO
HIP of Greater New York
NY
243 Dual-Eligible
Local CCP
031
1
HIP VIP Medicaid Advantage
HMO
HIP of Greater New York
NY
2,133 Dual-Eligible
H3336
NEIGHBORHOOD HEALTH PROVIDERS Local CCP LLC
003
0
Neighborhood Medicare Supreme
HMO
Bronx, Kings, New York, Queens
NY
308 Dual-Eligible
H3336
NEIGHBORHOOD HEALTH PROVIDERS Local CCP LLC
009
0
Neighborhood Extended Care
HMO
Kings and Queens, NY
NY
Dual-Eligible
H3337
LIBERTY HEALTH ADVANTAGE, INC.
Local CCP
002
0
HMO Liberty Health Advantage Dual PowerNassau
Nassau
NY
67 Dual-Eligible
H3337
LIBERTY HEALTH ADVANTAGE, INC.
Local CCP
003
0
Liberty Health HMO Advantage Dual Power NYC
NYC -Bronx, Kings, New York, Queens, Richmond
NY
632 Dual-Eligible
H3347
ELDERPLAN, INC.
Local CCP
002
0
Elderplan Access
HMO
New York City Metropolitan Area
NY
279 Dual-Eligible
H3359
MANAGED HEALTH, INC.
Local CCP
021
0
Healthfirst Life Improvement Plan
HMO
NYC, LI and Westchester Counties NY
38,934 Dual-Eligible
H3359
MANAGED HEALTH, INC.
Local CCP
026
0
Healthfirst Maximum Plan
HMO
New York Metropolitan Area
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
031
0
WellCare Access
HMO
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
043
0
WellCare Select
HMOPOS
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
047
0
WellCare Liberty
HMO
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
050
0
WellCare Liberty
HMO
New York County
NY
Dual-Eligible
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
065
0
WellCare Access
HMO
Upstate New York
NY
1,481 Dual-Eligible
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
084
0
WellCare Select
HMOPOS
Monroe and Wayne Counties
NY
206 Dual-Eligible
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
098
0
WellCare Select
HMOPOS
Upstate New York
NY
340 Dual-Eligible
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
105
0
WellCare Advocate Complete
HMO
Bronx, Kings, New York and Queens County
NY
71 Dual-Eligible
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
109
0
WellCare Access
HMO
New York County
NY
2,644 Dual-Eligible
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
110
0
WellCare Access
HMO
Kings County
NY
2,184 Dual-Eligible
SNP_200811.xls
PSO (State License)
Plan Geographic Name
Plan Enrollment
NY
78 Dual-Eligible
Bronx County
NY
1,866 Dual-Eligible
Bronx, Kings, New York, and Queens Counties
NY
534 Dual-Eligible
Albany County
NY
Dual-Eligible
Specialty Diseases
Page 29
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
111
0
WellCare Access
HMO
Queens County
NY
1,417 Dual-Eligible
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
116
0
WellCare Access
HMO
Nassau County
NY
178 Dual-Eligible
H3361
WELLCARE_OF NEW YORK, INC.
Local CCP
117
0
WellCare Select
HMOPOS
Nassau County
NY
Dual-Eligible
H3366
TOUCHSTONE HEALTH HMO, INC.
Local CCP
022
0
Touchstone Health Grand Plan
HMO
Bronx, Kings, Queens, Richmond & NY New York Counties
187 Dual-Eligible
H3370
EMPIRE HEALTHCHOICE HMO, INC.
Local CCP
018
0
MediBlue Total Solutions
HMO
NYC, Long Island, Mid-Hudson, & NY Capital Region
538 Dual-Eligible
H3379
UNITED HEALTHCARE OF NEW YORK, Local CCP INC.
036
0
Evercare Plan DH
HMO
Bronx, Kings, New York, Queens & NY Richmond Counties
141 Dual-Eligible
H3384
HEALTHNOW NEW YORK INC
Local CCP
044
0
Senior Blue 600
HMO
Northeastern New York
NY
26 Dual-Eligible
H3384
HEALTHNOW NEW YORK INC
Local CCP
045
0
Senior Blue 600
HMO
Western NewYork
NY
106 Dual-Eligible
H3387
AMERICHOICE OF NEW YORK, INC
Local CCP
005
0
AmeriChoice Personal HMO Care Plus
Kings, Queens, and Bronx Counties
NY
527 Dual-Eligible
H3456
UNITED HEALTHCARE OF NORTH CAROLINA
Local CCP
016
0
Evercare Plan DH
Select Counties in North Carolina
NC
9,091 Dual-Eligible
H3653
PARAMOUNT CARE, INC
Local CCP
020
0
Paramount Elite Plus - HMO Special Needs Plan
Paramount Elite Plus (NW Ohio)
OH
291 Dual-Eligible
H3659
UNITED HEALTHCARE OF OHIO, INC.
Local CCP
056
0
Evercare Plan DH
HMO
Select Counties in Ohio
OH
5,465 Dual-Eligible
H3749
PACIFICARE OF OKLAHOMA, INC.
Local CCP
011
0
Evercare Plan DH
HMO
Oklahoma City Area
OK
573 Dual-Eligible
H3749
PACIFICARE OF OKLAHOMA, INC.
Local CCP
012
0
Evercare Plan DH
HMO
Creek, Rogers & Tulsa Counties
OK
52 Dual-Eligible
H3810
MID ROGUE INDEPENDENT PHYSICIAN Local CCP ASSOCIATION
002
0
CareSource - SNP
HMO
Counties: Jackson, Josephine, Douglas*
OR
895 Dual-Eligible
H3811
SAMARITAN HEALTH PLANS, INC.
Local CCP
003
0
Samaritan Advantage Special Needs Plan
HMO
Benton and Linn counties
OR
1,700 Dual-Eligible
H3812
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
004
0
Evercare Plan DP
PPO
Clackamas, Lane, Multnomah & Washington Counties
OR
150 Dual-Eligible
H3814
ATRIO HEALTH PLANS
Local CCP
007
0
ATRIO MyAdvantage SNP
HMO
Coos, Douglas and Klamath Counties
OR
2,685 Dual-Eligible
H3818
FAMILYCARE HEALTH PLANS, INC.
Local CCP
002
0
PremierCare Plus
HMO
Portland Metro, OR Clatsop,Morrow,Umatilla Counties
1,089 Dual-Eligible
H3887
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan DH-POS HMOPOS
SNP_200811.xls
HMO
Cook, Du Page, Kane and Lake Counties
IL
Specialty Diseases
421 Dual-Eligible
Page 30
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H3907
UNIVERSITY OF PITTSBURGH MEDICAL CENTER
Local CCP
020
0
UPMC for Life Specialty HMO Plan
Western Pennsylvania
PA
16,494 Dual-Eligible
H3912
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan DP
PPO
Lancaster & York Counties
PA
487 Dual-Eligible
H3912
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
006
0
Evercare Plan DP
PPO
Bucks, Chester & Philadelphia Counties
PA
410 Dual-Eligible
H3912
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
007
0
Evercare Plan DP
PPO
Lehigh & Northampton
PA
36 Dual-Eligible
H3920
UNISON HEALTH PLAN OF PENNSYLVANIA, INC.
Local CCP
003
0
Unison Advantage Plus HMO
Select counties in Pennsylvania
PA
11,245 Dual-Eligible
H3931
AETNA HEALTH INC
Local CCP
069
0
Aetna Golden Medicare HMO Dual Advantage Plan
Philadelphia Metro and Lehigh Valley
PA
958 Dual-Eligible
H3949
BRAVO HEALTH PENNSYLVANIA INC.
Local CCP
009
0
Bravo Select
Allegheny, Philadelphia & surrounding Counties
PA
4,931 Dual-Eligible
H3952
KEYSTONE HEALTH PLAN EAST, INC.
Local CCP
018
0
Keystone 65 Complete HMO
Bucks,Chester,Delaware,Montgom PA ery and Phila Cty
22,611 Dual-Eligible
H3954
GEISINGER HEALTH PLAN
Local CCP
097
0
Geisinger Gold Secure HMO 1
Central Pennsylvania
PA
673 Dual-Eligible
H3957
KEYSTONE HEALTH PLAN WEST, INC. Local CCP
030
0
SecurityBlue HMO Care
HMO
Western Region
PA
826 Dual-Eligible
H3959
HEALTHAMERICA PENNSYLVANIA, INC. Local CCP
026
0
AdvantraOne
HMO
Western & Central Pennsylvania Counties
PA
646 Dual-Eligible
H3964
BRAVO HEALTH PENNSYLVANIA, INC. Local CCP
002
0
Senior Partners Silver
HMO
Philadelphia, Bucks and Montgomery Counties
PA
13,580 Dual-Eligible
H4003
MMM HEALTHCARE, INC.
Local CCP
010
0
Medicare y Mucho Mßs HMO - DIAMANTE
Puerto Rico
PR
851 Dual-Eligible
H4003
MMM HEALTHCARE, INC.
Local CCP
016
0
Medicare y Mucho Mßs HMO - DIAMANTE CARE
Puerto Rico
PR
Dual-Eligible
H4003
MMM HEALTHCARE, INC.
Local CCP
017
0
Medicare y Mucho Mßs HMO - DIAMANTE CHOICE
Puerto Rico
PR
59,809 Dual-Eligible
H4004
PREFERRED MEDICARE CHOICE, INC. Local CCP
001
0
Premier Plus
HMO
Puerto Rico
PR
579 Dual-Eligible
H4004
PREFERRED MEDICARE CHOICE, INC. Local CCP
047
0
Premier Select
HMO
Puerto Rico
PR
Dual-Eligible
H4004
PREFERRED MEDICARE CHOICE, INC. Local CCP
048
0
Premier Preferred
HMO
Puerto Rico
PR
37,597 Dual-Eligible
H4006
MCS ADVANTAGE INC.
013
0
MCS Classicare Ideal D HMO
Puerto Rico
PR
228 Dual-Eligible
SNP_200811.xls
Local CCP
HMO
Specialty Diseases
Page 31
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H4006
MCS ADVANTAGE INC.
Local CCP
015
0
MCS Classicare Ideal C HMO
Puerto Rico
PR
Dual-Eligible
H4006
MCS ADVANTAGE INC.
Local CCP
018
0
MCS Classicare Ideal E HMO
Puerto Rico
PR
1,509 Dual-Eligible
H4007
HUMANA HEALTH PLANS OF PUERTO Local CCP RICO INC
002
0
Humana Gold Plus HMO HMO SNP-DE H4007002
Puerto Rico Island Wide
PR
312 Dual-Eligible
H4007
HUMANA HEALTH PLANS OF PUERTO Local CCP RICO INC
005
0
Humana Gold Plus HMO HMO SNP-DE H4007005
Puerto Rico Island Wide
PR
8,681 Dual-Eligible
H4007
HUMANA HEALTH PLANS OF PUERTO Local CCP RICO INC
008
0
Humana Gold Plus HMO HMO SNP-DE H4007008
Puerto Rico Island Wide
PR
54 Dual-Eligible
H4009
SDM HEALTHCARE MANAGEMENT, INC.
Local CCP
006
0
SDM Medicare Platino HMO
Platino
PR
142 Dual-Eligible
H4009
SDM HEALTHCARE MANAGEMENT, INC.
Local CCP
007
0
SDM Medicare Platino HMO Dorado
Platino Dorado
PR
3,922 Dual-Eligible
H4009
SDM HEALTHCARE MANAGEMENT, INC.
Local CCP
009
0
SDM Medicare Platino HMO Plus
Platino Plus
PR
Dual-Eligible
H4012
TRIPLE-S, INC.
Local CCP
001
0
Triple-S Medicare Selecto
HMO
Island of Puerto Rico
PR
95 Dual-Eligible
H4012
TRIPLE-S, INC.
Local CCP
003
0
Triple-S Medicare Selecto Superior
HMO
Island of Puerto Rico
PR
33,698 Dual-Eligible
H4012
TRIPLE-S, INC.
Local CCP
004
0
Triple-S Medicare Selecto Plus
HMO
Island of Puerto Rico
PR
Dual-Eligible
H4012
TRIPLE-S, INC.
Local CCP
005
0
Triple-S Medicare Selecto 2
HMO
Island of Puerto Rico
PR
Dual-Eligible
H4106
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan DH
HMO
Bristol, Kent, Providence & Washington Counties
RI
810 Dual-Eligible
H4125
ARCADIAN HEALTH PLAN
Local CCP
005
0
Arcadian Health Plan - HMO Dual Plus
Oklahoma
OK
115 Dual-Eligible
H4152
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND
Local CCP
012
0
BlueCHiP for Medicare HMO Optima
State of Rhode Island
RI
H4206
INSTIL HEALTH INSURANCE COMPANY Local CCP
025
0
InStil MedCare
Selected counties in Georgia
GA
Dual-Eligible
H4407
HEALTHSPRING OF TENNESSEE, INC. Local CCP
003
0
HealthSpring TotalCare HMO
Northern Counties
MS
186 Dual-Eligible
H4407
HEALTHSPRING OF TENNESSEE, INC. Local CCP
004
0
HealthSpring TotalCare HMO
Southern
MS
266 Dual-Eligible
H4407
HEALTHSPRING OF TENNESSEE, INC. Local CCP
015
0
HealthSpring TotalCare HMO South
South
MS
236 Dual-Eligible
SNP_200811.xls
PPO
Specialty Diseases
3,058 Dual-Eligible
Page 32
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
H4454
HEALTHSPRING OF TENNESSEE, INC. Local CCP
008
0
HealthSpring East & West TotalCare
H4454
HEALTHSPRING OF TENNESSEE, INC. Local CCP
020
0
H4461
CARITEN HEALTH PLAN IN
Local CCP
011
H4506
SELECTCARE OF TEXAS, L.L.C.
Local CCP
H4510
Plan Type
State(s)
Special Needs Plan Type
South East and West Tennessee
TN
3,546 Dual-Eligible
HealthSpring Middle TN HMO TotalCare
Middle Tennessee
TN
3,614 Dual-Eligible
0
Cariten Senior Health Complete
East Tennessee
TN
10,262 Dual-Eligible
012
0
TexanChoice Powered HMO by CCRx
Greater Houston Metro Area
TX
86 Dual-Eligible
HUMANA HEALTH PLAN OF TEXAS,INC. Local CCP
017
0
Humana Gold Plus HMO HMO SNP-DE H4510017
Bexar and Nueces County
TX
887 Dual-Eligible
H4510
HUMANA HEALTH PLAN OF TEXAS,INC. Local CCP
019
0
Humana Gold Plus HMO HMO SNP-DE H4510019
Dallas County
TX
113 Dual-Eligible
H4513
TEXAS HEALTHSPRING LLC
Local CCP
010
0
Texas HealthSpring TotalCare
HMO
Texas HealthSpring Counties
TX
6,626 Dual-Eligible
H4514
EVERCARE OF TEXAS, LLC
Local CCP
001
0
Evercare Plan DH
HMO
Houston & Austin Surrounding Counties
TX
9,912 Dual-Eligible
H4521
TEXAS HEALTH SPRING LLC
Local CCP
002
0
Valley Advantage Select
HMO
Counties: HI, CA, WI
TX
2,157 Dual-Eligible
H4522
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
007
0
Evercare Plan DP
PPO
Dona Ana, Grant, Hidalgo, Luna & NM; TX Sierra Counties
H4523
AETNA HEALTH INC.
Local CCP
014
0
Aetna Golden Medicare HMO Dual Advantage Plan
Bexar County
TX
370 Dual-Eligible
H4525
SHA, L.L.C
Local CCP
003
0
FirstCare Advantage Select
HMO
FirstCare Advantage Select (Lubbock Region)
TX
976 Dual-Eligible
H4527
PSO HEALTH SERVICES, LLC
Local CCP
003
0
Physicians Health Choice Select
HMO
Travis, Hays, and Williamson Counties
TX
1,089 Dual-Eligible
H4527
PSO HEALTH SERVICES, LLC
Local CCP
004
0
Physicians Health Choice Select
HMO
Nueces, San Patricio, and Aransas TX Counties
2,315 Dual-Eligible
H4527
PSO HEALTH SERVICES, LLC
Local CCP
006
0
Physicians Health Choice Select
HMO
El Paso County
TX
522 Dual-Eligible
H4527
PSO HEALTH SERVICES, LLC
Local CCP
015
0
Physicians Health Choice Select
HMO
Cameron County
TX
290 Dual-Eligible
H4527
PSO HEALTH SERVICES, LLC
Local CCP
019
0
Physicians Health Choice Select
HMO
North Texas
TX
417 Dual-Eligible
H4528
BRAVO HEALTH TEXAS, INC.
Local CCP
002
0
Bravo Select
HMO
El Paso and Harris Counties
TX
2,654 Dual-Eligible
H4528
BRAVO HEALTH TEXAS, INC.
Local CCP
006
0
Bravo Select
HMO
Bexar County
TX
1,363 Dual-Eligible
SNP_200811.xls
HMO
Plan Geographic Name
Plan Enrollment
HMO
Specialty Diseases
2,587 Dual-Eligible
Page 33
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H4529
ARCADIAN HEALTH PLAN, INC.
Local CCP
007
0
Texas Commun. Care- HMO Dual Plus (El Paso)
El Paso County
TX
790 Dual-Eligible
H4590
PACIFICARE OF TEXAS, INC.
Local CCP
020
0
Evercare Plan DH
HMO
Dallas-Fort Worth Metroplex
TX
5,634 Dual-Eligible
H4590
PACIFICARE OF TEXAS, INC.
Local CCP
022
0
Evercare Plan DH
HMO
San Antonio Area
TX
7,086 Dual-Eligible
H4590
PACIFICARE OF TEXAS, INC.
Local CCP
033
0
Evercare Plan DH
HMO
Corpus Christi Area
TX
761 Dual-Eligible
H4604
UNITED HEALTHCARE OF UTAH
Local CCP
006
0
Evercare Plan DH-POS HMOPOS
Salt Lake and Ogden Surrounding UT Counties
855 Dual-Eligible
H4837
UNITEDHEALTHCARE OF WISCONSIN Local CCP
001
0
UnitedHealthcare of Wisconsin
HMO
Milwaukee
WI
H5008
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Premier
HMO
King,Kitsap,Pierce,Snohomish & Whatcom Counties
WA
1,322 Dual-Eligible
H5008
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
003
0
Evercare Premier
HMO
Spokane County
WA
145 Dual-Eligible
H5087
EASY CHOICE HEALTH PLAN INC.
Local CCP
001
0
Easy Choice Health Plan
HMO
Los Angeles County
CA
1,037 Dual-Eligible
H5189
UNISON HEALTH PLAN OF TENNESSEE, INC.
Local CCP
003
0
Unison Advantage Plus HMO
Northeast Arkansas
AR
16 Dual-Eligible
H5204
CARE WISCONSIN HEALTH PLAN, INC. Local CCP
002
0
Partnership
HMO
Dane County, Wisconsin
WI
250 Dual-Eligible
H5206
PARTNERSHIP HEALTH PLAN, INC.
Local CCP
002
0
Community Health Partnership
HMO
Chippewa, Dunn and Eau Claire Counties
WI
1,489 Dual-Eligible
H5206
PARTNERSHIP HEALTH PLAN, INC.
Local CCP
003
0
Community Health Partnership
HMO
Pierce and St. Croix Counties
WI
15 Dual-Eligible
H5207
COMMUNITY CARE HEALTH PLAN, INC Local CCP
001
0
Community Care's Partnership Program
HMO
Kenosha, Milwaukee, Racine and Waukesha Counties
WI
221 Dual-Eligible
H5209
CARE WISCONSIN HEALTH PLAN, INC. Local CCP
002
0
Partnership
HMO
Dane County, Wisconsin
WI
622 Dual-Eligible
H5215
NETWORK HEALTH INSURANCE CORPORATION
Local CCP
007
0
Network Cares
PPO
East Central Wisconsin
WI
206 Dual-Eligible
H5253
UNITED HEALTHCARE OF WISCONSIN, Local CCP INC
024
0
Evercare Plan DH-POS HMOPOS
Appleton,GreenBay,LaCrosse,Milw WI aukee,Madison areas
1,608 Dual-Eligible
H5294
SUPERIOR HEALTH PLAN, INC.
Local CCP
001
0
Superior HealthPlan
HMO
Superior HealthPlan
TX
46 Dual-Eligible
H5402
QUALITY HEALTH PLANS, INC.
Local CCP
024
0
Value One Florida
HMO
Florida
FL
456 Dual-Eligible
H5404
UNIVERSAL HEALTH CARE, INC.
Local CCP
110
0
Universal DP
HMO
Broward, Dade & Palm Beach Counties
FL
Dual-Eligible
H5404
UNIVERSAL HEALTH CARE, INC.
Local CCP
111
0
Universal DP
HMO
Tampa Bay Area
FL
52 Dual-Eligible
H5407
CITRUS HEALTH CARE, INC.
Local CCP
011
0
Citrus Special Needs Plan
HMO
HMO Service Area
FL
12,648 Dual-Eligible
SNP_200811.xls
Specialty Diseases
Dual-Eligible
Page 34
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H5420
MEDICA HEALTHCARE PLANS, INC.
Local CCP
006
0
Medica HealthCare Plans MedicareMax Plus
PSO (State License)
Miami-Dade and Broward County
FL
992 Dual-Eligible
H5424
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan DP
PPO
Honolulu County
HI
1,095 Dual-Eligible
H5425
SCAN HEALTH PLAN
Local CCP
010
0
SCAN Health Plan
HMO
SCAN Los Angeles County - Medi- CA Medi
752 Dual-Eligible
H5425
SCAN HEALTH PLAN
Local CCP
011
0
SCAN Health Plan
HMO
SCAN Riverside County - MediMedi
CA
205 Dual-Eligible
H5425
SCAN HEALTH PLAN
Local CCP
012
0
SCAN Health Plan
HMO
SCAN San Bernardino County Medi-Medi
CA
149 Dual-Eligible
H5426
METCARE HEALTH PLANS, INC.
Local CCP
013
0
AdvantageCare Total- HMO Assist
Treasure Coast
FL
307 Dual-Eligible
H5426
METCARE HEALTH PLANS, INC.
Local CCP
014
0
AdvantageCare Total- HMO Assist
Gulf Coast
FL
253 Dual-Eligible
H5426
METCARE HEALTH PLANS, INC.
Local CCP
015
0
AdvantageCare Total- HMO Assist
Central Florida Market
FL
70 Dual-Eligible
H5427
FREEDOM HEALTH PLAN, INC.
Local CCP
068
0
Freedom Medi-Medi Plan
Florida
FL
1,683 Dual-Eligible
H5428
SAN MATEO HEALTH COMMISSION
Local CCP
001
0
HPSM CareAdvantage HMO
San Mateo County
CA
7,361 Dual-Eligible
H5430
CARE1ST HEALTH PLAN OF ARIZONA
Local CCP
001
0
ONECare by Care1st Health Plan Arizona
HMO
County: Maricopa
AZ
1,621 Dual-Eligible
H5433
ORANGE COUNTY HEALTH AUTHORITY
Local CCP
001
0
OneCare
HMO
OneCare (serves only Orange County)
CA
8,258 Dual-Eligible
H5440
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan DH
HMO
Orlando and Tampa areas plus Broward County
FL
903 Dual-Eligible
H5517
COVENTRY HEALTH AND LIFE INS. COMPANY
Local CCP
004
0
AdvantraOne
PPO
West Virginia
WV
66 Dual-Eligible
H5528
GROUP HEALTH INCORPORATED
Local CCP
013
0
GHI Medicare PPO Value
PPO
Counties of New York City
NY
751 Dual-Eligible
H5528
GROUP HEALTH INCORPORATED
Local CCP
014
0
GHI Medicare PPO Value
PPO
Westchester and Rockland Counties
NY
99 Dual-Eligible
H5539
MARYLAND CARE - MEDICARE, INC.
Local CCP
001
0
Golden Advantage Plus PSO (State License)
Allegany, Garrett and Washington MD Counties
67 Dual-Eligible
H5549
VNS CHOICE
Local CCP
001
0
VNS CHOICE Medicare HMO Option I
Bronx, Kings, New York, Queens and Richmond County
NY
1,422 Dual-Eligible
H5549
VNS CHOICE
Local CCP
002
0
VNS CHOICE Medicare HMO Option II
Bronx, Kings, New York, Queens, Richmond Counties
NY
260 Dual-Eligible
SNP_200811.xls
HMO
Specialty Diseases
Page 35
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H5549
VNS CHOICE
Local CCP
003
0
VNS CHOICE Managed Long Term Care Plus
HMO
Bronx, Kings, New York, Queens, Richmond Counties
NY
Dual-Eligible
H5554
SANTA CLARA COUNTY HEALTH AUTHORITY
Local CCP
001
0
Healthy Generations
HMO
Santa Clara County
CA
3,129 Dual-Eligible
H5577
MCS ADVANTAGE INC.
Local CCP
002
0
RedMed Platino
HMO
RedMed Platino
PR
33,056 Dual-Eligible
H5578
ARCADIAN HEALTH PLAN OF GEORGIA, INC.
Local CCP
007
0
Southeast Community HMO Care - Dual Plus
Athens, Columbus & Macon
GA
503 Dual-Eligible
H5580
SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION
Local CCP
001
0
Mercy Care Advantage HMO
Maricopa, Pima and Santa Cruz Counties
AZ
14,827 Dual-Eligible
H5587
HEALTH CHOICE ARIZONA, INC.
Local CCP
001
0
Health Choice Generations
HMO
Northern AZ, Maricopa,Pima,Pinal AZ and Gila Counties
3,252 Dual-Eligible
H5588
MOLINA HEALTHCARE OF NEVADA, INC.
Local CCP
001
0
Molina Medicare Options Plus
HMO
Clark and Washoe Area
NV
599 Dual-Eligible
H5590
BRIDGEWAY HEALTH SOLUTIONS
Local CCP
001
0
Bridgeway Health Solutions
HMO
Bridgeway Health Solutions
AZ
151 Dual-Eligible
H5594
OPTIMUM HEALTHCARE, INC.
Local CCP
004
0
Optimum Emerald Plan HMO
Hernando, Hillsborough, Pasco, Pinellas and Sumter
FL
17 Dual-Eligible
H5608
DENVER HEALTH MEDICAL PLAN, INC. Local CCP
001
0
Denver Health Medicare Choice
Denver County
CO
1,127 Dual-Eligible
H5609
GEMCARE HEALTH PLAN INC.
Local CCP
002
0
GEMCare Medicare HMO Plus Dual Eligible Plan
Kern County
CA
325 Dual-Eligible
H5619
ARCADIAN HEALTH PLAN, INC.
Local CCP
003
0
Northeast Community Care - Dual Plus
HMO
Cumberland, York, Lewiston, and Bangor
ME
1,363 Dual-Eligible
H5628
MOLINA HEALTHCARE OF UTAH, INC.
Local CCP
001
0
Molina Medicare Options Plus
HMO
Davis, Iron, Salt Lake, Utah, Washington, Weber
UT
2,154 Dual-Eligible
H5628
MOLINA HEALTHCARE OF UTAH, INC.
Local CCP
006
0
Healthy Advantage by HMO Molina Medicare
Davis, Iron, Salt Lake, Utah, Washington, Weber
UT
Dual-Eligible
H5640
IEHP HEALTH ACCESS
Local CCP
001
0
IEHP Medicare DualChoice
HMO
Riverside and San Bernardino Counties
CA
2,319 Dual-Eligible
H5649
CENTRAL HEALTH PLAN OF CALIFORNIA, INC.
Local CCP
002
0
Central Health MediMedi Plan
HMO
Los Angeles County & Partial San CA Bernardino County
761 Dual-Eligible
H5685
MIDWEST HEALTH PLAN, INC.
Local CCP
001
0
Midwest Advantage
HMO
Midwest Advantage of Wayne and MI Oakland Counties
288 Dual-Eligible
H5696
PHYSICIANS UNITED PLAN, INC.
Local CCP
021
0
PUP Extra
HMO
Florida
384 Dual-Eligible
SNP_200811.xls
HMO
FL
Specialty Diseases
Page 36
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
003
0
Windsor Medicare Extra Comprehensive Plan
HMO
Middle Tennessee and Jefferson County Alabama
AL; TN
3,264 Dual-Eligible
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
009
0
Windsor Medicare Extra Comprehensive Plan
HMO
West Tennessee and North Mississippi
MS; TN
5,258 Dual-Eligible
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
022
0
Windsor Medicare Extra Comprehensive Plan
HMO
Central and Northeast Arkansas
AR
2,040 Dual-Eligible
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
030
0
Windsor Medicare Extra Comprehensive Plan
HMO
Central Mississippi
MS
3,332 Dual-Eligible
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
038
0
Windsor Medicare Extra Comprehensive Plan
HMO
East Tennessee and Greenville/Spartanburg, SC
SC; TN
893 Dual-Eligible
H5698
WINDSOR HEALTH PLANS, INC.
Local CCP
058
0
Windsor Medicare Extra Comprehensive Plan
HMO
Northwest Arkansas
AR
433 Dual-Eligible
H5700
ARKANSAS COMMUNITY CARE
Local CCP
018
0
Arkansas Comm. Care - HMO Dual Plus
Arkansas
AR
126 Dual-Eligible
H5703
SOUTH COUNTRY HEALTH ALLIANCE
Local CCP
001
0
AbilityCare
HMO
Select Counties in Minnesota
MN
685 Dual-Eligible
H5746
AMERIGROUP NEW MEXICO, INC.
Local CCP
006
0
AMERIVANTAGE Specialty + Rx
HMO
Bernalillo County
NM
272 Dual-Eligible
H5750
METROPOLITAN HEALTH PLAN
Local CCP
004
0
MHP Integrated Care Initiative SNP
HMO
Hennepin County
MN
25 Dual-Eligible
H5756
DELAWARE PHYSICIANS CARE, INC.
Local CCP
001
0
Delaware Physicians Care Advantage
PSO (State License)
New Castle County
DE
Dual-Eligible
H5760
COOPERATIVA DE SEGUROS DE VIDA Local CCP DE PUERTO RICO
004
0
CosviMed Care Platino+
HMOPOS
Puerto Rico
PR
4,629 Dual-Eligible
H5760
COOPERATIVA DE SEGUROS DE VIDA Local CCP DE PUERTO RICO
005
0
CosviMed Care Platino HMOPOS
Puerto Rico
PR
Dual-Eligible
H5760
COOPERATIVA DE SEGUROS DE VIDA Local CCP DE PUERTO RICO
006
0
Cosvimed Care Platino HMOPOS Mix
Puerto Rico
PR
Dual-Eligible
SNP_200811.xls
Specialty Diseases
Page 37
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H5774
AMERICAN HEALTH, INC.
Local CCP
004
0
Basic Plus
HMO
Puerto Rico
PR
H5774
AMERICAN HEALTH, INC.
Local CCP
016
0
Basic Extra PLus
HMO
Puerto RIco
PR
Dual-Eligible
H5774
AMERICAN HEALTH, INC.
Local CCP
019
0
Basic Plus 2
HMO
Puerto Rico
PR
13,581 Dual-Eligible
H5774
AMERICAN HEALTH, INC.
Local CCP
020
0
Basic Plus 3
HMO
Puerto Rico
PR
Dual-Eligible
H5782
SOLANO-NAPA-YOLO COMMISSION ON Local CCP MEDICAL CARE
001
0
PartnershipAdvantage HMO
Napa, Solano, and Yolo Counties
CA
2,801 Dual-Eligible
H5783
ARCADIAN HEALTH PLAN, INC.
Local CCP
008
0
Southeast Comm. Care- HMO Dual Plus(Greenville)
Greenville, Pickens, & Spartanburg SC
658 Dual-Eligible
H5810
MOLINA HEALTHCARE OF CALIFORNIA Local CCP
001
0
Molina Medicare Options Plus
LA, San Diego, parts of Riverside & CA San Bernardino
1,457 Dual-Eligible
H5811
MEDCORE HP
Local CCP
002
0
Medcore Gold Select HMO (Medicare & Medi-Cal)
San Joaquin County
CA
497 Dual-Eligible
H5813
AETNA HEALTH, INC
Local CCP
005
0
Aetna Golden Medicare HMO Dual Advantage Plan
New Castle County
DE
124 Dual-Eligible
H5817
AMERIGROUP TEXAS, INC.
Local CCP
009
0
AMERIVANTAGE Specialty + Rx
HMO
Houston Metro Area
TX
4,446 Dual-Eligible
H5817
AMERIGROUP TEXAS, INC.
Local CCP
015
0
AMERIVANTAGE Specialty + Rx
HMO
Bexar County (San Antonio)
TX
282 Dual-Eligible
H5821
MAPFRE LIFE INSURANCE COMPANY
Local CCP
009
0
MAPFRE Medicare Excel Platino Open
HMOPOS
State of Puerto Rico
PR
38 Dual-Eligible
H5821
MAPFRE LIFE INSURANCE COMPANY
Local CCP
014
0
MAPFRE Medicare HMOPOS Excel Platino Hybrid 1
State of Puerto Rico
PR
Dual-Eligible
H5821
MAPFRE LIFE INSURANCE COMPANY
Local CCP
017
0
MAPFRE Medicare HMOPOS Excel Platino Closed 1
State of Puerto Rico
PR
7,384 Dual-Eligible
H5821
MAPFRE LIFE INSURANCE COMPANY
Local CCP
018
0
MAPFRE Medicare HMOPOS Excel Platino Hybrid 2
State of Puerto Rico
PR
Dual-Eligible
H5821
MAPFRE LIFE INSURANCE COMPANY
Local CCP
019
0
MAPFRE Medicare HMOPOS Excel Platino Closed 2
State of Puerto Rico
PR
Dual-Eligible
H5823
MOLINA HEALTHCARE OF WASHINGTON, INC.
Local CCP
001
0
Molina Medicare Options Plus
Central Puget Sound and Spokane WA area
546 Dual-Eligible
H5826
COMMUNITY HEALTH PLAN OF WASHINGTON
Local CCP
005
0
Community HealthFirst HMO MA SNP
Eastern and Western Washington State
WA
416 Dual-Eligible
H5838
COMMONWEALTH CARE ALLIANCE
Local CCP
001
0
Commonwealth Care Connection
Greater Boston, Springfield, Merrimack Valley
MA
215 Dual-Eligible
SNP_200811.xls
HMO
HMO
HMO
Specialty Diseases
224 Dual-Eligible
Page 38
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H5850
SUMMIT HEALTH PLAN, INC.
Local CCP
002
0
Summit Maximum Plan HMO
Dade, Broward, Palm Beach, Martin and St. Lucie
FL
4,170 Dual-Eligible
H5859
HEALTH PLAN OF CAREOREGON, INC. Local CCP
001
0
CareOregon Advantage HMO
Portland/Salem Area, Northwest and Southern Oregon
OR
5,189 Dual-Eligible
H5887
FIRST MEDICAL HEALTH PLAN, INC.
Local CCP
006
0
First+Plus Platino Premium
HMO
Entire Island Puerto Rico
PR
50 Dual-Eligible
H5887
FIRST MEDICAL HEALTH PLAN, INC.
Local CCP
008
0
First+Plus Platino Classic
HMO
Entire Island Puerto Rico
PR
Dual-Eligible
H5887
FIRST MEDICAL HEALTH PLAN, INC.
Local CCP
009
0
First+Plus Platino - Plus HMO
Entire Island Puerto Rico
PR
Dual-Eligible
H5895
CONTRA COSTA CO MED SVCS DBA CONTRA COSTA HEALTH
Local CCP
001
0
SelectCare
HMO
Contra Costa County
CA
90 Dual-Eligible
H5896
AMERIGROUP MARYLAND, INC.
Local CCP
007
0
AMERIVANTAGE Specialty + Rx
HMO
Central Maryland
MD
563 Dual-Eligible
H5926
MOLINA HEALTHCARE OF MICHIGAN
Local CCP
001
0
Molina Medicare Options Plus
HMO
Detroit/Flint Metro and Grand Rapids Metro area
MI
1,645 Dual-Eligible
H5928
CARE1ST HEALTH PLAN
Local CCP
001
0
Care1st Dual Plus Plan HMO
Care1st Health Plan Los Angeles County
CA
2,201 Dual-Eligible
H5928
CARE1ST HEALTH PLAN
Local CCP
005
0
Care1st Dual Plus Plan HMO
Care1st Health Plan Orange County
CA
51 Dual-Eligible
H5928
CARE1ST HEALTH PLAN
Local CCP
007
0
Care1st Dual Plus Plan HMO
Care1st Health Plan San Bernardino County
CA
212 Dual-Eligible
H5928
CARE1ST HEALTH PLAN
Local CCP
009
0
Care1st Dual Plus Plan HMO
Care1st Health Plan San Diego County
CA
975 Dual-Eligible
H5932
GATEWAY HEALTH PLAN, INC.
Local CCP
001
0
Gateway Health Plan Medicare Assured
HMO
Pennsylvania
PA
23,786 Dual-Eligible
H5948
ARTA MEDICARE HEALTH PLAN, INC.
Local CCP
002
0
Arta Select
HMO
Arta Select
CA
226 Dual-Eligible
H5949
SENIOR WHOLE HEALTH, LLC
Local CCP
001
0
Senior Whole Health of HMO Connecticut
Fairfield, Hartford, Middlesex, New CT Haven
481 Dual-Eligible
H5969
ALOHACARE
Local CCP
002
0
AlohaCare Advantage HMO Plus
State of Hawaii
HI
422 Dual-Eligible
H5985
ABRAZO ADVANTAGE HEALTH PLAN
Local CCP
002
0
Abrazo Advantage Plus HMO
Central Arizona
AZ
2,748 Dual-Eligible
H5991
AFFINITY HEALTH PLAN, INC.
Local CCP
001
0
Affinity Medicare Ultimate
HMO
New York City (5 Boroughs)
NY
895 Dual-Eligible
H5991
AFFINITY HEALTH PLAN, INC.
Local CCP
002
0
Affinity Medicare Solutions
HMO
New York City (5 Boroughs)
NY
427 Dual-Eligible
SNP_200811.xls
Specialty Diseases
Page 39
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H5992
SENIOR WHOLE HEALTH, LLC
Local CCP
001
0
Senior Whole Health of HMO New York
Capital District, Ulster Co., Duchess Co.
NY
611 Dual-Eligible
H5992
SENIOR WHOLE HEALTH, LLC
Local CCP
002
0
Senior Whole Health PLUS of New York
Capital District, Ulster Co., Duchess Co.
NY
Dual-Eligible
H5995
MARION POLK COMMUNITY HEALTH PLAN ADVANTAGE, INC.
Local CCP
001
0
Marion Polk Community HMO HealthPlan Advantage
Marion and Polk Counties In Oregon
OR
3,233 Dual-Eligible
H5998
UNISON HEALTH PLAN OF TENNESSEE, INC.
Local CCP
003
0
Unison Advantage Plus HMO
Southwest Tennessee
TN
2,061 Dual-Eligible
H6178
CARESOURCE
Local CCP
001
0
CareSource Advantage HMO
17 counties in the most populated areas of Ohio
OH
242 Dual-Eligible
H6181
AMERIGROUP NEW YORK, LLC
Local CCP
007
0
AMERIVANTAGE Specialty + Rx
HMO
New York City Area
NY
260 Dual-Eligible
H6497
MENNONITE GENERAL HOSPITAL, INC. Local CCP
003
0
Mennonite Platino Basic
HMO
Menonita Platino Basico
PR
Dual-Eligible
H6497
MENNONITE GENERAL HOSPITAL, INC. Local CCP
005
0
Mennonite Platino Extended
HMO
Menonita Platino Extendido
PR
Dual-Eligible
H6497
MENNONITE GENERAL HOSPITAL, INC. Local CCP
006
0
Mennonite Platino Alternate
HMO
Menonita Platino Alterno
PR
Dual-Eligible
H6864
GUILDNET, INC.
Local CCP
001
0
GuildNet Gold
HMOPOS
Kings, Queens, New York and the NY Bronx counties
118 Dual-Eligible
H6934
UAHC HEALTH PLAN OF TENNESSEE, Local CCP INC.
001
0
UAHC Gold Plus
HMO
Shelby County
TN
755 Dual-Eligible
H6952
GREAT LAKES HEALTH PLAN, INC.
Local CCP
001
0
Great Lakes Health Plan
HMO
Macomb, Oakland and Wayne Counties
MI
268 Dual-Eligible
H7015
HEALTHFIRST HEALTH PLAN OF NEW Local CCP JERSEY, INC.
004
0
Healthfirst NJ Maximum HMO
Bergen, Essex, Hudson, Passaic, Union Counties
NJ
Dual-Eligible
H7065
GROUP HEALTH COOPERATIVE OF EAU CLAIRE
Local CCP
001
0
Wisconsin Personal Care Plan
HMO
West Central Wisconsin
WI
Dual-Eligible
H7086
COMMUNITY HEALTH GROUP
Local CCP
001
0
CommuniCare Advantage
HMO
San Diego County California
CA
425 Dual-Eligible
H7146
SAN MIGUEL HEALTH PLAN, INC.
Local CCP
002
0
San Miguel Health Plan, Preferred
HMO
Los Angeles County
CA
1,285 Dual-Eligible
H7179
ARCADIAN HEALTH PLAN OF LOUISIANA, INC.
Local CCP
003
0
Arcadian Community Care - Dual Plus
HMO
Shreveport, Monroe & Lake Charles
LA
916 Dual-Eligible
H7187
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan DH-POS HMOPOS
Chesterfld,Goochlnd,Hanover,Henri VA co,Richmond City
460 Dual-Eligible
H7187
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan DH-POS HMOPOS
Arlington County
SNP_200811.xls
HMO
VA
Specialty Diseases
Dual-Eligible
Page 40
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
H7200
AMERIGROUP TENNESSEE, INC.
Local CCP
006
0
AMERIVANTAGE Specialty + Rx
H7292
ALAMEDA ALLIANCE JOINT POWERS AUTHORITY (JPA)
Local CCP
001
0
H7352
UPH/MIHS VENTURES L.L.C.
Local CCP
002
H7352
UPH/MIHS VENTURES L.L.C.
Local CCP
H7475
Plan Type
State(s)
Special Needs Plan Type
Nashville
TN
648 Dual-Eligible
Alliance CompleteCare HMO
Alameda County
CA
768 Dual-Eligible
0
University Physicians Care Advantage
HMO
Pima County
AZ
391 Dual-Eligible
003
0
Maricopa Care Advantage
HMO
Maricopa County
AZ
725 Dual-Eligible
CARE WISCONSIN HEALTH PLAN, INC. Local CCP
001
0
Partnership
HMO
Columbia, Dodge, Jefferson & Sauk Counties
WI
42 Dual-Eligible
H7526
MEDICA HEALTH PLAN
Local CCP
002
0
Medica Access Ability
HMO
Select Minnesota Counties
MN
188 Dual-Eligible
H7678
MOLINA HEALTHCARE OF TEXAS, INC. Local CCP
001
0
Molina Medicare Options Plus
HMO
Bexar, Galveston and Harris area
TX
381 Dual-Eligible
H8031
GATEWAY HEALTH PLAN OF OHIO, INC.
Local CCP
001
0
Gateway Health Plan Medicare Assured
HMO
Ohio
OH
50 Dual-Eligible
H8189
MANAGED HEALTH SERVICES, WISCONSIN
Local CCP
001
0
Managed Health Services
HMO
Managed Health Services
WI
Dual-Eligible
H8742
ABRI HEALTH PLAN, INC
Local CCP
004
0
Today's Health Choice HMO Powered by CCRx
Greater Milwaukee Metro Area
WI
Dual-Eligible
H8991
AMERIGROUP FLORIDA, INC.
Local CCP
011
0
AMERIVANTAGE Specialty + Rx
HMO
South Florida
FL
108 Dual-Eligible
H8991
AMERIGROUP FLORIDA, INC.
Local CCP
017
0
AMERIVANTAGE Specialty + Rx
HMO
Central Florida
FL
543 Dual-Eligible
H9001
FALLON COMMUNITY HEALTH PLAN
Local CCP
012
0
Fallon Senior Plan Value 1
HMO
WORC county,parts of FRK,HMD,HPS,MSEX,NOF counties
MA
905 Dual-Eligible
H9001
FALLON COMMUNITY HEALTH PLAN
Local CCP
018
0
Fallon Senior Plan Value 2
HMO
WORC county
MA
56 Dual-Eligible
H9011
UNITED HEALTHCARE OF FLORIDA INC.
Local CCP
011
0
Evercare Plan DH
HMO
Miami-Dade County
FL
36 Dual-Eligible
H9082
MOLINA HEALTHCARE OF NEW MEXICO, INC.
Local CCP
001
0
Molina Medicare Options Plus
HMO
Bernalillo,DonaAna,McKinley,Otero NM ,SanJuan,Valencia
104 Dual-Eligible
H9104
SCAN HEALTH PLAN
Local CCP
013
0
SCAN Health Plan
HMO
SCAN Los Angeles County - Medi- CA Medi HCBS
152 Dual-Eligible
H9104
SCAN HEALTH PLAN
Local CCP
014
0
SCAN Health Plan
HMO
SCAN Riverside County - MediMedi HCBS
SNP_200811.xls
HMO
Plan Geographic Name
Plan Enrollment
CA
Specialty Diseases
76 Dual-Eligible
Page 41
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H9104
SCAN HEALTH PLAN
Local CCP
015
0
SCAN Health Plan
HMO
SCAN San Bernardino County Medi-Medi HCBS
CA
51 Dual-Eligible
H9385
SCAN HEALTH PLAN OF ARIZONA
Local CCP
001
0
SCAN Health Plan Arizona
HMO
SCAN Maricopa County
AZ
1,007 Dual-Eligible
H9882
VIRGINIA PREMIER HEALTH PLAN, INC. Local CCP
001
0
Virginia Premier Gold
HMO
Tidewater, Richmond, Roanoke
VA
251 Dual-Eligible
H9882
VIRGINIA PREMIER HEALTH PLAN, INC. Local CCP
002
0
Virginia Premier Gold Plus
HMO
Tidewater, Richmond, Roanoke
VA
30 Dual-Eligible
H9951
FIRSTSOLUTIONS DBA FIRST PLAN OF Local CCP MINNESOTA
001
0
FirstPlan Blue Basic
HMO
Northeastern Minnesota
MN
46 Dual-Eligible
R3175
UNITED HEALTHCARE INSURANCE COMPANY
Regional CCP
003
0
Evercare Plan RDP
Regional PPO
State of Hawaii
HI
262 Dual-Eligible
R5287
UNITED HEALTHCARE INSURANCE COMPANY
Regional CCP
003
0
Evercare Plan RDP
Regional PPO
State of Florida
FL
9,466 Dual-Eligible
R5342
UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK
Regional CCP
003
0
Evercare Plan RDP
Regional PPO
State of New York
NY
3,901 Dual-Eligible
H0150
HEALTHSPRING OF ALABAMA, INC.
Local CCP
015
0
HealthSpring SpecialCare
HMO
Alabama
AL
Institutional
H0151
UNITED HEALTHCARE OF ALABAMA, INC.
Local CCP
017
0
Evercare Plan IH
HMO
Jefferson & Mobile Counties
AL
Institutional
H0319
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
PPO
Maricopa, Pima, Pinal and Yuma Counties
AZ
1,067 Institutional
H0408
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IH-POS HMOPOS
Davidson, DeKalb, Hickman and Rutherford Counties
TN
Institutional
H0408
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan IH-POS HMOPOS
Anderson, Blount, Knox and Loudon Counties
TN
45 Institutional
H0410
UNITED HEALTHCARE INSURANCE COMPANY
Demo
004
0
Erickson Advantage Guardian
Continuing Care Retirement Community
Wayne and Oakland Counties
MI
Institutional
H0543
PACIFICARE OF CALIFORNIA/SECURE Local CCP HORIZONS
131
0
Evercare Plan IH
HMO
San Francisco, Alameda, and Contra Costa Counties
CA
90 Institutional
H0544
CAREMORE HEALTH PLAN
Local CCP
005
0
CareMore Touch
HMO
Los Angeles and Orange Counties CA (partial)
356 Institutional
H0620
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan IP
PPO
Denver, Colorado Springs Area
CO
2,169 Institutional
H0624
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
004
0
Evercare Plan IH
HMO
Fremont County
CO
21 Institutional
H0710
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
PPO
Fairfld, Hrtfrd, Lthfld, New Hvn, Tollnd, Wndham
CT
1,323 Institutional
Under-11
Specialty Diseases
90 Dual-Eligible
SNP_200811.xls
Page 42
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
H1108
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
H1286
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
H1415
HEALTHSPRING, INC.
Local CCP
010
H1509
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
H1717
UNITED HEALTHCARE INSURANCE COMPANY
Plan Type
State(s)
Special Needs Plan Type
Atlanta and Macon Metro Areas
GA
2,636 Institutional
Evercare Plan IH-POS HMOPOS
Marion County
OR
26 Institutional
0
HealthSpring SpecialCare
HMO
Cook, DuPage, Kane, Lake and Will
IL
Institutional
006
0
Evercare Plan IP
PPO
Indianapolis area
IN
Institutional
Local CCP
009
0
Evercare Plan IP
PPO
Johnson and Wyandotte Counties KS
Institutional
H1777
CATHOLIC SPECIAL NEEDS PLAN, LLC Local CCP
001
0
ArchCare Advantage
HMO
Bronx, New York and Richmond Counties
NY
376 Institutional
H2003
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
PPO
Cumberland, Kennebec, Sagadahoc & York Counties
ME
Institutional
H2108
BRAVO HEALTH MID- ATLANTIC INC.
Local CCP
020
0
Bravo Traditions
HMO
Baltimore and DC Metro Areas
MD
195 Institutional
H2111
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
PPO
Baltimore,East Shore MD,DC,DE, surrounding areas
DC; DE; MD; VA
H2174
TRILLIUM COMMUNITY HEALTH PLAN
Local CCP
003
0
Trillium Advantage ISNP
HMO
Lane , Jackson counties
OR
30 Institutional
H2228
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
PPO
Boston, Springfield and Worcester MA Metro Areas
3,385 Institutional
H2228
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
002
0
Evercare Plan IP
PPO
Bristol, Kent, Providence and Washington Counties
RI
1,275 Institutional
H2323
FIDELIS SECURECARE OF MICHIGAN
Local CCP
005
0
Fidelis Secure Comfort HMO
Michigan
MI
1,091 Institutional
H2323
FIDELIS SECURECARE OF MICHIGAN
Local CCP
006
0
Fidelis Secure Comfort HMO Plus
Michigan
MI
40 Institutional
H2323
FIDELIS SECURECARE OF MICHIGAN
Local CCP
007
0
Fidelis Secure Independence
HMO
Michigan
MI
Institutional
H2406
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
PPO
Cleveland, Cincinnati and Columbus Areas
OH
H2802
UNITED HEALTHCARE OF THE MIDLANDS, INC.
Local CCP
005
0
Evercare Plan IH
HMO
Pottawattamie, Douglas & Sarpy Counties
IA; NE
H2803
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
011
0
Evercare Plan IH-POS HMOPOS
Polk, Dallas & Warren Counties
IA
Institutional
H3113
OXFORD HEALTH PLANS (NJ), INC.
Local CCP
001
0
Evercare Plan IH
HMO
Bergen,Essex,Hudson,Morris,Pass NJ aic,Somerset, Union
310 Institutional
H3209
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
PPO
Bernalillo County
SNP_200811.xls
PPO
Plan Geographic Name
Plan Enrollment
NM
Specialty Diseases
2,615 Institutional
2,163 Institutional 144 Institutional
75 Institutional
Page 43
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H3337
LIBERTY HEALTH ADVANTAGE, INC.
Local CCP
004
0
Liberty Health Advantage Secure Choice
HMO
Bronx, Kings, New York, Queens, Richmond, Nassau
NY
Institutional
H3347
ELDERPLAN, INC.
Local CCP
001
0
Elderplan Classic
HMO
New York City Metropolitan Area
NY
329 Institutional
H3347
ELDERPLAN, INC.
Local CCP
003
0
Elderplan Advantage
HMO
New York City Metropolitan Area
NY
112 Institutional
H3362
INDEPENDENT HEALTH ASSOCIATION, Local CCP INC.
020
0
Independent Health Medicare Family Choice
HMO
Erie and Niagara Counties
NY
1,330 Institutional
H3379
UNITED HEALTHCARE OF NEW YORK, Local CCP INC.
002
0
Evercare Plan IH
HMO
New York Metropolitan Area
NY
4,385 Institutional
H3379
UNITED HEALTHCARE OF NEW YORK, Local CCP INC.
022
0
Evercare Plan IH
HMO
Upstate New York
NY
1,600 Institutional
H3456
UNITED HEALTHCARE OF NORTH CAROLINA
Local CCP
010
0
Evercare Plan IH
HMO
Select Counties in North Carolina
NC
1,495 Institutional
H3659
UNITED HEALTHCARE OF OHIO, INC.
Local CCP
057
0
Evercare Plan IH
HMO
Lake, Lorain & Lucas counties
OH
75 Institutional
H3659
UNITED HEALTHCARE OF OHIO, INC.
Local CCP
058
0
Evercare Plan IH
HMO
Clark, Greene & Warren Counties
OH
117 Institutional
H3708
SELECTCARE OF OKLAHOMA, INC.
Local CCP
001
0
Tribute Powered by CCRx
HMO
Greater Ardmore and Surrounding OK Area
155 Institutional
H3749
PACIFICARE OF OKLAHOMA, INC.
Local CCP
013
0
Evercare Plan IH
HMO
Oklahoma City Area
OK
Institutional
H3749
PACIFICARE OF OKLAHOMA, INC.
Local CCP
015
0
Evercare Plan IH
HMO
Creek, Rogers & Tulsa Counties
OK
Institutional
H3812
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan IP
PPO
Clackamas, Lane, Multnomah & Washington Counties
OR
190 Institutional
H3887
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IH-POS HMOPOS
Cook, Du Page, Kane and Lake Counties
IL
190 Institutional
H3912
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
PPO
Philadelphia, Harrisburg, York & Surrounding Areas
PA
1,029 Institutional
H3949
BRAVO HEALTH PENNSYLVANIA INC.
Local CCP
016
0
Bravo Traditions
HMO
Philadelphia, Bucks, Delaware &Montgomery Cnty
PA
145 Institutional
H3954
GEISINGER HEALTH PLAN
Local CCP
106
0
Geisinger Gold Secure HMO 2
Central Pennsylvania
PA
Institutional
H4004
PREFERRED MEDICARE CHOICE, INC. Local CCP
035
0
Medicare en el Hogar Plus
HMO
Puerto Rico
PR
749 Institutional
H4454
HEALTHSPRING OF TENNESSEE, INC. Local CCP
013
0
HealthSpring SpecialCare
HMO
Middle, South East and West Tennessee
TN
164 Institutional
SNP_200811.xls
Specialty Diseases
Page 44
Contract Number
Contract Name
Organization Type
Plan ID Segment ID
Plan Name
Plan Type
Plan Geographic Name
State(s)
Plan Enrollment
Special Needs Plan Type
H4456
UNITED HEALTHCARE PLAN OF THE RIVER VALLEY, INC.
Local CCP
024
0
Evercare Plan IH-POS HMOPOS
Bradley, Hamilton & McMinn Counties
TN
Institutional
H4506
SELECTCARE OF TEXAS, L.L.C.
Local CCP
013
0
Tribute Powered by CCRx
HMO
Greater Houston Metro Area
TX
Institutional
H4513
TEXAS HEALTHSPRING LLC
Local CCP
015
0
Texas HealthSpring SpecialCare
HMO
Texas HealthSpring Counties
TX
Institutional
H4514
EVERCARE OF TEXAS, LLC
Local CCP
005
0
Evercare Plan IH
HMO
Travis and Williamson Counties
TX
Institutional
H4590
PACIFICARE OF TEXAS, INC.
Local CCP
031
0
Evercare Plan IH
HMO
Bexar, Guadalupe & Kendall Counties
TX
39 Institutional
H4590
PACIFICARE OF TEXAS, INC.
Local CCP
034
0
Evercare Plan IH
HMO
Collin, Dallas, Denton & Tarrant Counties
TX
44 Institutional
H4604
UNITED HEALTHCARE OF UTAH
Local CCP
007
0
Evercare Plan IH-POS HMOPOS
Salt Lake and Weber Counties
UT
Institutional
H5008
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IH
HMO
King,Kitsap,Pierce,Snohomish & Whatcom Counties
WA
357 Institutional
H5008
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
005
0
Evercare Plan IH
HMO
Spokane County
WA
Institutional
H5253
UNITED HEALTHCARE OF WISCONSIN, Local CCP INC
007
0
Evercare Plan IH-POS HMOPOS
Appleton,GreenBay,LaCrosse,Milw WI aukee,Madison areas
H5404
UNIVERSAL HEALTH CARE, INC.
Local CCP
112
0
Universal IP
HMO
South Florida
FL
H5404
UNIVERSAL HEALTH CARE, INC.
Local CCP
113
0
Universal IP
HMO
Tampa Bay Area
FL
Institutional
H5417
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IP
PPO
Panhandle, Jax, Tampa, Orlando & FL Southern FL areas
1,587 Institutional
H5575
FIDELIS SECURECARE OF NORTH CAROLINA
Local CCP
005
0
Fidelis Secure Comfort HMO
North Carolina
NC
719 Institutional
H5575
FIDELIS SECURECARE OF NORTH CAROLINA
Local CCP
006
0
Fidelis Secure Comfort HMO Plus
North Carolina
NC
12 Institutional
H5575
FIDELIS SECURECARE OF NORTH CAROLINA
Local CCP
007
0
Fidelis Secure Independence
HMO
North Carolina
NC
41 Institutional
H5652
UNITED HEALTHCARE INSURANCE COMPANY
Demo
003
0
Erickson Advantage Guardian
Continuing Care Retirement Community
Baltimore, Montgomery and Prince MD Georges Counties
122 Institutional
H5678
UNITED HEALTHCARE INSURANCE COMPANY
Demo
003
0
Erickson Advantage Guardian
Continuing Care Retirement Community
Fairfax County
VA
Institutional
H5697
UNITED HEALTHCARE INSURANCE COMPANY
Demo
004
0
Erickson Advantage Guardian
Continuing Care Retirement Community
Bucks
PA
Institutional
SNP_200811.xls
Specialty Diseases
766 Institutional Institutional
Page 45
Contract Number
Contract Name
H5754
UNITED HEALTHCARE INSURANCE COMPANY
H5893
Organization Type
Plan Name
Plan Type
Plan Geographic Name
State(s)
Special Needs Plan Type
003
0
Erickson Advantage Guardian
Continuing Care Retirement Community
Essex County
MA
18 Institutional
CARE WISCONSIN HEALTH PLAN, INC. Local CCP
001
0
InFocus Health
HMO
Columbia, Dane, Dodge & Sauk Counties, Wisconsin
WI
13 Institutional
H5918
UNITED HEALTHCARE INSURANCE COMPANY
003
0
Erickson Advantage Guardian
Continuing Care Retirement Community
Monmouth and Morris Counties
NJ
28 Institutional
H5980
FIDELIS SECURECARE OF TEXAS, INC. Local CCP
005
0
Fidelis Secure Comfort HMO
Texas Area
TX
245 Institutional
H5980
FIDELIS SECURECARE OF TEXAS, INC. Local CCP
006
0
Fidelis Secure Comfort HMO Plus
Texas Area
TX
Institutional
H5980
FIDELIS SECURECARE OF TEXAS, INC. Local CCP
007
0
Fidelis Secure Independence
HMO
Texas Area
TX
Institutional
H5989
COMPREHENSIVE CARE MANAGEMENT CORP.
Local CCP
002
0
CCM Direct - Dual Eligible
HMO
New York City Metro Area and Westchester County
NY
16 Institutional
H5989
COMPREHENSIVE CARE MANAGEMENT CORP.
Local CCP
003
0
CCM Direct - Medicare HMO Only
New York City Metro Area and Westchester County
NY
Institutional
H7187
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
001
0
Evercare Plan IH-POS HMOPOS
Arlington County
VA
Institutional
H7187
UNITED HEALTHCARE INSURANCE COMPANY
Local CCP
007
0
Evercare Plan IH-POS HMOPOS
Chesterfld,Goochlnd,Hanover,Henri VA co,Richmond City
Institutional
H9101
ELDERPLAN, INC. - SHMO
Local CCP
007
0
Elderplan, Inc.
HMO
New York City Metropolitan Area
NY
15,616 Institutional
H9104
SCAN HEALTH PLAN
Local CCP
006
0
SCAN Health Plan
HMO
SCAN Los Angeles County - SNP
CA
37,765 Institutional
H9104
SCAN HEALTH PLAN
Local CCP
007
0
SCAN Health Plan
HMO
SCAN Orange County - SNP
CA
14,621 Institutional
H9104
SCAN HEALTH PLAN
Local CCP
008
0
SCAN Health Plan
HMO
SCAN Riverside County - SNP
CA
18,415 Institutional
H9104
SCAN HEALTH PLAN
Local CCP
009
0
SCAN Health Plan
HMO
SCAN San Bernardino County SNP
CA
6,548 Institutional
R5595
AETNA LIFE INSURANCE COMPANY
Regional CCP
006
0
Aetna Golden Choice Care Advantage Plan
Regional PPO
New Jersey
NJ
Institutional
Under-11
Demo
Plan ID Segment ID
Plan Enrollment
Demo
Specialty Diseases
62 Institutional
SNP_200811.xls
Page 46
