special needs plan comprehensive report - snpalliance.org · a record with fictitious contract...

NOTES:

Data is as of May 2018

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.

SNP Type

Number of

Contracts

Number

of Plans

Sub Total

Enrollment SNP Type Enrollment

Number of

Plans

Chronic or Disabling Condition 58 132 351,158 Chronic or Disabling Condition 65 10

Dual-Eligible 190 412 2,234,694 Dual-Eligible 14 10

Institutional 49 97 75,433 Institutional 8 16

Totals 297 641 2,661,285 Under - 11 Totals 87 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 Specialty Diseases

H0294 CARE IMPROVEMENT PLUS

WISCONSIN INSURANCE COMPANY

Local CCP 002 0 Care Improvement

Plus Gold Rx (PPO

SNP)

Local PPO Select counties in Wisconsin WI 2,270 Chronic or

Disabling

Condition

Cardio DIS CHF and Diabetes



Local CCP 010 0 Care Improvement

Plus Gold Rx (PPO

SNP)

Local PPO Select counties in Wisconsin WI 153 Chronic or

Disabling

Condition


H0351 HEALTH NET OF ARIZONA, INC. Local CCP 038 0 Allwell CHF/Diabetes

Medicare (HMO SNP)

HMO Maricopa and Pinal Counties AZ 1,961 Chronic or

Disabling

Condition

CHF Diabetes

H0351 HEALTH NET OF ARIZONA, INC. Local CCP 042 0 Allwell Cardio

Medicare (HMO SNP)

HMO Maricopa and Pinal Counties AZ 329 Chronic or

Disabling

Condition

Cardiovascular Disorders

H0354 CIGNA HEALTHCARE OF ARIZONA,

INC.

Local CCP 027 0 Cigna-HealthSpring

Achieve Plus (HMO

SNP)

HMO Maricopa Co. and Select Zip

Codes in Pinal Co.

AZ 4,690 Chronic or

Disabling

Condition

Diabetes Mellitus

H0544 BLUE CROSS OF CALIFORNIA Local CCP 004 0 Anthem Diabetes

(HMO SNP)

HMO Los Angeles and Orange Counties CA 10,298 Chronic or

Disabling

Condition

Diabetes Mellitus


(HMO SNP)

HMO San Bernardino County CA 1,791 Chronic or

Disabling

Condition

Diabetes Mellitus

Under - 11Aggregate Information

Special Needs Plan Comprehensive Report

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H0544 BLUE CROSS OF CALIFORNIA Local CCP 013 0 Anthem Heart (HMO

SNP)


Disabling

Condition

Cardio Disorders CHF

H0544 BLUE CROSS OF CALIFORNIA Local CCP 014 0 Anthem Breathe (HMO

SNP)


Disabling

Condition

Chronic Lung Failure

H0544 BLUE CROSS OF CALIFORNIA Local CCP 015 0 Anthem ESRD (HMO

SNP)


Disabling

Condition

End Stage Renal


SNP)

HMO San Bernardino County CA 419 Chronic or

Disabling

Condition


H0544 BLUE CROSS OF CALIFORNIA Local CCP 020 0 Anthem ESRD (HMO

SNP)


Disabling

Condition

End Stage Renal


SNP)

HMO Santa Clara, San Benito County CA 138 Chronic or

Disabling

Condition



(HMO SNP)


Disabling

Condition

Diabetes Mellitus


SNP)

HMO Stanislaus County CA 173 Chronic or

Disabling

Condition



(HMO SNP)


Disabling

Condition

Diabetes Mellitus


SNP)


Disabling

Condition



SNP)


Disabling

Condition



SNP)


Disabling

Condition


H0562 HEALTH NET OF CALIFORNIA,INC. Local CCP 092 0 Health Net Jade (HMO

SNP)

HMO Kern, L. A. and Orange Counties CA 7,035 Chronic or

Disabling

Condition


SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H0562 HEALTH NET OF CALIFORNIA,INC. Local CCP 114 0 Health Net Jade (HMO

SNP)

HMO San Diego CA 217 Chronic or

Disabling

Condition


H0838 UNIVERSAL CARE, INC. Local CCP 020 0 Brand New Day

Harmony Choice for

Medi-Medi (HMO SNP)

HMO KER KIN LA ORA RIV SBD CA 2,345 Chronic or

Disabling

Condition

Chronic Mental Health

H0838 UNIVERSAL CARE, INC. Local CCP 026 0 Brand New Day In

Control Drug Savings

(HMO SNP)

HMO Counties: KER KIN LA ORA RIV

SBD

CA 1,455 Chronic or

Disabling

Condition

Diabetes Mellitus

H0838 UNIVERSAL CARE, INC. Local CCP 027 0 Brand New Day In

Control Choice for

Medi-Medi (HMO SNP)

HMO KER KIN LA ORA RIV SBD CA 1,403 Chronic or

Disabling

Condition

Diabetes Mellitus


Bridges Drug Savings

(HMO SNP)

HMO KER LA ORA RIV SBD CA 145 Chronic or

Disabling

Condition

Dementia


Bridges Choice for

Medi-Medi (HMO SNP)

HMO KER LA ORA RIV SBD CA 76 Chronic or

Disabling

Condition

Dementia


Harmony Drug

Savings (HMO SNP)

HMO KIN KER LA ORA RIV SBD CA 283 Chronic or

Disabling

Condition

Chronic Mental Health


Embrace Care Drug

Savings (HMO SNP)

HMO FRE IMP KER KIN LA ORA RIV

SBD SD SM SCL TUL

CA 3,590 Chronic or

Disabling

Condition



Embrace Choice for

Medi-Medi (HMO SNP)

HMO FRE IMP KIN KER LA ORA RIV

SBD SD SM SCL TUL

CA 1,848 Chronic or

Disabling

Condition


H1032 WELLCARE OF FLORIDA, INC. Local CCP 184 0 WellCare Guardian

(HMO SNP)

HMO Select Counties in FL FL 19 Chronic or

Disabling

Condition


H1032 WELLCARE OF FLORIDA, INC. Local CCP 186 0 WellCare Guardian

(HMO SNP)

HMO Select Counties in FL FL Chronic or

Disabling

Condition


SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H1036 HUMANA MEDICAL PLAN, INC. Local CCP 121 0 Humana Gold Plus -

Diabetes (HMO SNP)

HMO Broward County FL 1,179 Chronic or

Disabling

Condition

Diabetes Mellitus


Diabetes (HMO SNP)

HMO Palm Beach County FL 966 Chronic or

Disabling

Condition

Diabetes Mellitus


Diabetes (HMO SNP)

HMO Flagler and Volusia counties FL 611 Chronic or

Disabling

Condition

Diabetes Mellitus


Diabetes (HMO SNP)

HMO Tampa Metro Area FL 728 Chronic or

Disabling

Condition

Diabetes Mellitus


Diabetes (HMO SNP)

HMO Jacksonville Area FL 711 Chronic or

Disabling

Condition

Diabetes Mellitus

H1036 HUMANA MEDICAL PLAN, INC. Local CCP 234 0 Humana Community

HMO Diabetes and

Heart (HMO SNP)

HMO Jefferson County KY 579 Chronic or

Disabling

Condition


H1045 PREFERRED CARE PARTNERS, INC. Local CCP 018 0 Preferred Special Care

Miami-Dade (HMO

SNP)

HMO Miami-Dade County FL 2,407 Chronic or

Disabling

Condition


H1343 FRESENIUS HEALTH PLANS OF

TEXAS, INC.

Local CCP 001 0 Fresenius Total Health

(HMO SNP)

HMO Cook County IL 28 Chronic or

Disabling

Condition

End Stage Renal

H1468 HUMANA BENEFIT PLAN OF ILLINOIS,

INC.

Local CCP 017 0 Humana Community

HMO Diabetes and

Heart (HMO SNP)

HMO Cook, DuPage and Will counties IL 5,234 Chronic or

Disabling

Condition


H1951 HUMANA HEALTH BENEFIT PLAN OF

LOUISIANA, INC.

Local CCP 044 0 Humana Gold Plus -

Diabetes and Heart

(HMO SNP)

HMO Jefferson and Orleans Parishes LA 1,931 Chronic or

Disabling

Condition


H2108 BRAVO HEALTH MID-ATLANTIC, INC. Local CCP 029 0 Cigna-HealthSpring

Achieve (HMO SNP)

HMO Maryland, Washington DC and

Delaware Counties

DC; DE; MD 694 Chronic or

Disabling

Condition

Diabetes Mellitus


Achieve (HMO SNP)

HMO Select Maryland Counties MD 801 Chronic or

Disabling

Condition

Diabetes Mellitus

H2334 EON HEALTH, INC. (SC) Local CCP 001 0 EON GOLD (PPO

SNP)

Local PPO Select South Carolina Counties SC Chronic or

Disabling

Condition


SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H2593 CAREMORE HEALTH PLAN OF

ARIZONA, INC.

Local CCP 005 0 CareMore COPD

(HMO SNP)

HMO Pima County AZ 839 Chronic or

Disabling

Condition



ARIZONA, INC.

Local CCP 006 0 CareMore Diabetes

(HMO SNP)

HMO Pima County AZ 3,117 Chronic or

Disabling

Condition

Diabetes Mellitus


ARIZONA, INC.

Local CCP 013 0 CareMore Heart Care

(HMO SNP)

HMO Pima County AZ 1,005 Chronic or

Disabling

Condition


H2649 HUMANA HEALTH PLAN, INC. Local CCP 053 0 Humana Gold Plus -

Diabetes and Heart

(HMO SNP)

HMO Corpus Christi Metro Area TX 410 Chronic or

Disabling

Condition


H2649 HUMANA HEALTH PLAN, INC. Local CCP 054 0 Humana Gold Plus -

Diabetes and Heart

(HMO SNP)

HMO San Antonio Metro Area TX 936 Chronic or

Disabling

Condition


H2649 HUMANA HEALTH PLAN, INC. Local CCP 056 0 Humana Kidney Care

(HMO-POS SNP)

HMOPOS Houston Metro Area TX 305 Chronic or

Disabling

Condition

End Stage Renal

H2649 HUMANA HEALTH PLAN, INC. Local CCP 060 0 Humana Kidney Care

(HMO-POS SNP)

HMOPOS Denver/Colorado Springs Metro

Area

CO 57 Chronic or

Disabling

Condition

End Stage Renal

H2758 BEHEALTHY FLORIDA, INC. Local CCP 005 0 BlueMedicare

Preferred HMO (HMO

SNP)

HMO Manatee and Sarasota counties FL 532 Chronic or

Disabling

Condition


H2758 BEHEALTHY FLORIDA, INC. Local CCP 007 0 BlueMedicare

Preferred HMO (HMO

SNP)

HMO Clay and Duval counties FL 710 Chronic or

Disabling

Condition


H2773 QUALITY HEALTH PLANS OF NEW

YORK, INC.

Local CCP 003 0 Advantage Health LI -

SNP (HMO SNP)

HMO Nassau, and Suffolk Counties NY 961 Chronic or

Disabling

Condition



YORK, INC.

Local CCP 017 0 Advantage Health

NYC - SNP (HMO

SNP)

HMO Queens County and Staten Island NY 132 Chronic or

Disabling

Condition


H3132 AHF MCO OF FLORIDA, INC. Local CCP 001 0 PHP (HMO SNP) HMO Broward, Miami-Dade and Duval

Counties, Florida

FL 1,539 Chronic or

Disabling

Condition

HIV Aids

H3240 AMERIGROUP NEW JERSEY, INC. Local CCP 017 0 Amerivantage ESRD

(HMO-POS SNP)

HMOPOS Select Counties in New Jersey NJ 155 Chronic or

Disabling

Condition

End Stage Renal

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H3262 FRESENIUS HEALTH PLANS OF NEW

YORK, INC.


(HMO SNP)

HMO Bronx, Kings, New York, and

Queens Counties

NY 37 Chronic or

Disabling

Condition

End Stage Renal

H3447 HEALTHKEEPERS, INC. Local CCP 003 0 Anthem MediBlue

COPD (HMO SNP)

HMO Richmond Metropolitan, West &

So. of Richmond Area

VA 393 Chronic or

Disabling

Condition



Diabetes (HMO SNP)



VA 1,637 Chronic or

Disabling

Condition

Diabetes Mellitus

H3572 AHF MCO OF GEORGIA, INC. Local CCP 001 0 PHP (HMO SNP) HMO Fulton County, Georgia GA Chronic or

Disabling

Condition

HIV Aids

H3815 ALIGNMENT HEALTH PLAN Local CCP 010 0 Alignment Health Plan

Heart & Diabetes

(HMO SNP)

HMO Los Angeles and North Orange

Counties

CA 981 Chronic or

Disabling

Condition


H3930 SPARTAN PLAN NY, INC. Local CCP 002 0 Sunrise Advantage

Plan C-SNP (HMO

SNP)

HMO New York (partial) NY 26 Chronic or

Disabling

Condition

Dementia

H3949 BRAVO HEALTH PENNSYLVANIA, INC. Local CCP 024 0 Cigna-HealthSpring

Achieve (HMO SNP)

HMO Select Pennsylvania Counties PA 2,563 Chronic or

Disabling

Condition

Diabetes Mellitus

H3962 KEYSTONE HEALTH PLAN CENTRAL,

INC.

Local CCP 018 0 BlueJourney Alliance

Lung Care (HMO SNP)

HMO Lancaster County PA Chronic or

Disabling

Condition


H3962 KEYSTONE HEALTH PLAN CENTRAL,

INC.

Local CCP 019 0 BlueJourney Alliance

Heart and Diabetes

Care (HMO SNP)

HMO Lancaster County PA Chronic or

Disabling

Condition


H4003 MMM HEALTHCARE, LLC Local CCP 009 0 MMM - Supremo

(HMO SNP)

HMO Puerto Rico PR 6,509 Chronic or

Disabling

Condition


H4236 SPARTAN PLAN PA, INC. Local CCP 002 0 Sunrise Advantage

Plan C-SNP (HMO

SNP)

HMO Pennsylvania (partial) PA 39 Chronic or

Disabling

Condition

Dementia

H4346 HMO COLORADO, INC. Local CCP 005 0 Anthem Breathe (HMO

SNP)

HMO Clark County NV 569 Chronic or

Disabling

Condition


H4346 HMO COLORADO, INC. Local CCP 006 0 Anthem Diabetes

(HMO SNP)

HMO Clark County NV 1,886 Chronic or

Disabling

Condition

Diabetes Mellitus

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H4346 HMO COLORADO, INC. Local CCP 008 0 Anthem Heart (HMO

SNP)

HMO Clark County NV 471 Chronic or

Disabling

Condition


H4590 UNITEDHEALTHCARE BENEFITS OF

TEXAS, INC.

Local CCP 037 0 UnitedHealthcare

Chronic Complete

(HMO SNP)

HMO San Antonio Metro Area TX 5,619 Chronic or

Disabling

Condition

Cardiovascular Disorders, Chronic

Heart Failure, Diabetes Mellitus

H4778 SPARTAN PLAN IL, INC. Local CCP 002 0 Sunrise Advantage

Plan C-SNP (HMO

SNP)

HMO Illinois (partial) IL 40 Chronic or

Disabling

Condition

Dementia

H5425 SCAN HEALTH PLAN Local CCP 028 0 Heart First (HMO SNP) HMO Orange County CA 639 Chronic or

Disabling

Condition


H5425 SCAN HEALTH PLAN Local CCP 033 0 Heart First (HMO SNP) HMO Riverside and San Bernardino

Counties

CA 712 Chronic or

Disabling

Condition


H5425 SCAN HEALTH PLAN Local CCP 034 0 SCAN Balance (HMO

SNP)


Disabling

Condition

Diabetes Mellitus

H5425 SCAN HEALTH PLAN Local CCP 047 0 Heart First (HMO SNP) HMO Marin County CA 75 Chronic or

Disabling

Condition



SNP)

HMO Marin County CA 87 Chronic or

Disabling

Condition

Diabetes Mellitus

H5425 SCAN HEALTH PLAN Local CCP 053 0 Heart First (HMO SNP) HMO Napa and Sonoma Counties CA 67 Chronic or

Disabling

Condition



SNP)

HMO Napa and Sonoma Counties CA 107 Chronic or

Disabling

Condition

Diabetes Mellitus

H5425 SCAN HEALTH PLAN Local CCP 055 0 Scripps Heart First

offered by SCAN

Health Plan (HMO

SNP)

HMO San Diego County CA 73 Chronic or

Disabling

Condition


H5427 FREEDOM HEALTH, INC. Local CCP 070 0 Freedom VIP Care

(HMO SNP)

HMO Select Counties in Florida FL 3,705 Chronic or

Disabling

Condition


H5427 FREEDOM HEALTH, INC. Local CCP 072 0 Freedom VIP Savings

(HMO SNP)


Disabling

Condition


SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



COPD (HMO SNP)


Disabling

Condition



(HMO SNP)


Disabling

Condition



COPD (HMO SNP)

HMO Select Counties in Florida FL 506 Chronic or

Disabling

Condition


H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 012 0 Simply Level (HMO

SNP)

HMO Miami-Dade County FL 1,877 Chronic or

Disabling

Condition

Diabetes Mellitus


SNP)

HMO Polk County FL 1,493 Chronic or

Disabling

Condition

Diabetes Mellitus


SNP)

HMO Orange, Osceola and Seminole

Counties

FL 726 Chronic or

Disabling

Condition

Diabetes Mellitus


SNP)

HMO Hillsborough, Pinellas, Hernando,

Pasco Counties

FL 170 Chronic or

Disabling

Condition

Diabetes Mellitus


SNP)

HMO Broward County FL 103 Chronic or

Disabling

Condition

Diabetes Mellitus


SNP)

HMO Palm Beach FL 24 Chronic or

Disabling

Condition

Diabetes Mellitus

H5496 IMPERIAL HEALTH PLAN OF

CALIFORNIA, INC.

Local CCP 005 0 Senior Value (HMO

SNP)

HMO County: San Francisco CA Chronic or

Disabling

Condition


H5496 IMPERIAL HEALTH PLAN OF

CALIFORNIA, INC.

Local CCP 010 0 Senior Value-LA (HMO

SNP)

HMO County: Los Angeles CA Chronic or

Disabling

Condition


H5591 MARTIN'S POINT GENERATIONS

ADVANTAGE, INC.

Local CCP 007 0 Martin's Point

Generations

Advantage Focus DC

(HMO SNP)

HMO Cumberland ME 172 Chronic or

Disabling

Condition

Diabetes Mellitus

H5594 OPTIMUM HEALTHCARE, INC. Local CCP 028 0 Optimum Diamond

Rewards (HMO SNP)


Disabling

Condition


SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



Rewards COPD (HMO

SNP)


Disabling

Condition



Rewards (HMO SNP)


Disabling

Condition



Rewards COPD (HMO

SNP)

HMO Select Counties in Florida FL 440 Chronic or

Disabling

Condition



Rewards (HMO SNP)

HMO select counties in FL FL Chronic or

Disabling

Condition



Rewards COPD (HMO

SNP)

HMO select counties in FL FL Chronic or

Disabling

Condition


H5619 ARCADIAN HEALTH PLAN, INC. Local CCP 046 0 Humana Gold Plus -

Diabetes and Heart

(HMO SNP)

HMO Richmond - Tidewater area VA 1,810 Chronic or

Disabling

Condition



Diabetes and Heart

(HMO SNP)

HMO Select counties in Kentucky and

Indiana

IN; KY 981 Chronic or

Disabling

Condition



Diabetes and Heart

(HMO SNP)

HMO Greenville Metro Area SC 173 Chronic or

Disabling

Condition


H5649 CENTRAL HEALTH PLAN OF

CALIFORNIA, INC.

Local CCP 006 0 Central Health Focus

Plan (HMO SNP)

HMO Counties: LA, SB, and partial OC CA 2,122 Chronic or

Disabling

Condition


H5652 SIERRA HEALTH AND LIFE

INSURANCE COMPANY, INC.

Local CCP 004 0 Erickson Advantage

Champion (HMO-POS

SNP)

HMOPOS Erickson Campuses -

CO,KS,MA,MD,MI,NJ,PA,TX,VA,N

C

CO; KS;

MA; MD; MI;

NC; NJ; PA;

TX; VA

1,575 Chronic or

Disabling

Condition

Cardiovascular Disorders, Chronic

Heart Failure, Diabetes Mellitus

H5774 TRIPLE S ADVANTAGE, INC. Local CCP 022 0 Vital Plus (HMO SNP) HMO Puerto Rico PR 2,229 Chronic or

Disabling

Condition


H5817 AMERIGROUP TEXAS, INC. Local CCP 025 0 Amerivantage ESRD

(HMO-POS SNP)

HMOPOS Bexar, Comal, El Paso, Hays,

Travis, Williamson

TX 294 Chronic or

Disabling

Condition

End Stage Renal

H5852 AIDS HEALTHCARE FOUNDATION Local CCP 001 0 PHP (HMO SNP) HMO Los Angeles County, California CA 719 Chronic or

Disabling

Condition

HIV Aids

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H5943 SCAN HEALTH PLAN Local CCP 001 0 VillageHealth (HMO-

POS SNP)

HMOPOS Riverside and San Bernardino

Counties

CA 856 Chronic or

Disabling

Condition

End Stage Renal

H5943 SCAN HEALTH PLAN Local CCP 002 0 VillageHealth (HMO-

POS SNP)

HMOPOS Los Angeles and Orange Counties CA 615 Chronic or

Disabling

Condition

End Stage Renal

H6320 FRESENIUS HEALTH PLANS OF

NORTH CAROLINA, INC.


(HMO SNP)

HMO Durham, Orange, and Wake

Counties

NC 164 Chronic or

Disabling

Condition

End Stage Renal

H6622 HUMANA WI HEALTH ORGANIZATION

INSURANCE CORP


Diabetes and Heart

(HMO SNP)

HMO Cincinnati and Columbus area KY; OH 2,910 Chronic or

Disabling

Condition



INSURANCE CORP


Diabetes and Heart

(HMO SNP)

HMO Clark and Nye (partial) counties NV 6,459 Chronic or

Disabling

Condition



INSURANCE CORP

Local CCP 030 0 Humana Gold Plus

SNP-CLD H6622-030

(HMO SNP)

HMO Clark and Nye (partial) counties NV 1,804 Chronic or

Disabling

Condition



INSURANCE CORP

Local CCP 031 0 Humana Kidney Care

(HMO SNP)

HMO Clark and Nye (partial) counties NV 249 Chronic or

Disabling

Condition

End Stage Renal

H6672 EON HEALTH, INC. (GA) Local CCP 003 0 EON SILVER (HMO

SNP)

HMO Select Georgia Counties GA 80 Chronic or

Disabling

Condition


H7802 SPARTAN PLAN VA, INC. Local CCP 002 0 Sunrise Advantage

Plan C-SNP (HMO

SNP)

HMO Virginia (partial) VA 21 Chronic or

Disabling

Condition

Dementia

H8170 AMERICA'S 1ST CHOICE OF SOUTH

CAROLINA, INC.

Local CCP 002 0 AFC Special Care Rx

(HMO SNP)

HMO Select Counties in SC SC 231 Chronic or

Disabling

Condition


H8552 ANTHEM BLUE CROSS LIFE AND

HEALTH INS COMPANY

Local CCP 028 0 Anthem MediBlue

ESRD (PPO SNP)

Local PPO Select Counties in California CA 476 Chronic or

Disabling

Condition

End Stage Renal

H9312 FRESENIUS HEALTH PLANS

INSURANCE COMPANY


(PPO SNP)

Local PPO Maricopa County AZ 142 Chronic or

Disabling

Condition

End Stage Renal

H9312 FRESENIUS HEALTH PLANS

INSURANCE COMPANY


(PPO SNP)

Local PPO San Diego County CA 118 Chronic or

Disabling

Condition

End Stage Renal

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H9403 EON HEALTH, INC. (SC) Local CCP 003 0 EON SILVER (HMO

SNP)

HMO Select South Carolina Counties SC 87 Chronic or

Disabling

Condition


H9589 EON HEALTH, INC. (GA) Local CCP 001 0 EON GOLD (PPO

SNP)

Local PPO Select Georgia Counties GA Chronic or

Disabling

Condition


H9915 MEDSTAR FAMILY CHOICE, INC. Local CCP 007 0 MedStar Medicare

Choice Care

Advantage (HMO

SNP)

HMO DC Metro DC 77 Chronic or

Disabling

Condition

CHF Diabetes


Choice Care

Advantage (HMO

SNP)

HMO Baltimore Metro, Baltimore and

DC Suburb

MD 1,420 Chronic or

Disabling

Condition

CHF Diabetes

R3444 CARE IMPROVEMENT PLUS SOUTH

CENTRAL INSURANCE CO.

Regional CCP 008 0 Care Improvement

Plus Silver Rx

(Regional PPO SNP)

Regional PPO Arkansas and Missouri AR; MO 6,234 Chronic or

Disabling

Condition

CHF Diabetes




Plus Gold Rx

(Regional PPO SNP)

Regional PPO Arkansas and Missouri AR; MO 19,265 Chronic or

Disabling

Condition


R6801 CARE IMPROVEMENT PLUS OF

TEXAS INSURANCE COMPANY


Plus Silver Rx

(Regional PPO SNP)

Regional PPO Texas TX 7,437 Chronic or

Disabling

Condition

CHF Diabetes




Plus Gold Rx

(Regional PPO SNP)

Regional PPO Texas TX 30,529 Chronic or

Disabling

Condition


R7444 UNITEDHEALTHCARE INSURANCE

COMPANY


Plus Silver Rx

(Regional PPO SNP)

Regional PPO Georgia and South Carolina GA; SC 26,376 Chronic or

Disabling

Condition

CHF Diabetes


COMPANY


Plus Gold Rx

(Regional PPO SNP)

Regional PPO Georgia and South Carolina GA; SC 67,357 Chronic or

Disabling

Condition


Under-11 65 Chronic or

Disabling

Condition

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H0028 CHA HMO, INC. Local CCP 007 0 Humana Gold Plus

SNP-DE H0028-007

(HMO SNP)

HMO Douglas County NE 81 Dual-Eligible

H0150 HEALTHSPRING OF ALABAMA, INC. Local CCP 007 0 Cigna-HealthSpring

TotalCare (HMO SNP)

HMO Select Alabama Counties AL 18,659 Dual-Eligible

H0154 VIVA HEALTH, INC. Local CCP 012 0 VIVA Medicare Extra

Value (HMO SNP)

HMO Northwest Alabama, Central

Alabama and Mobile Area

AL 18,277 Dual-Eligible

H0169 UNITEDHEALTHCARE OF THE

MIDWEST, INC.

Local CCP 001 0 UnitedHealthcare Dual

Complete (HMO SNP)

HMO Select Counties in IA IA 2,518 Dual-Eligible


MIDWEST, INC.


Complete (HMO SNP)

HMO Select Counties in MO MO 4,740 Dual-Eligible


MIDWEST, INC.


Complete (HMO SNP)

HMO Select Counties in NE NE 2,981 Dual-Eligible

H0174 TODAY'S OPTIONS OF TEXAS, INC. Local CCP 001 0 TexanPlus Star (HMO

SNP)

HMO Select counties in Southeast

Texas

TX 717 Dual-Eligible

H0251 UNITEDHEALTHCARE PLAN OF THE

RIVER VALLEY, INC.


Complete (HMO SNP)

HMO Select counties in Tennessee TN 53,853 Dual-Eligible FIDE SNP

H0251 UNITEDHEALTHCARE PLAN OF THE

RIVER VALLEY, INC.


Complete ONE (HMO

SNP)

HMO Select Counties in TN TN 1,854 Dual-Eligible FIDE SNP

H0321 ARIZONA PHYSICIANS IPA, INC. Local CCP 002 0 UnitedHealthcare Dual

Complete (HMO SNP)

HMO Select counties in Arizona AZ 49,815 Dual-Eligible

H0321 ARIZONA PHYSICIANS IPA, INC. Local CCP 004 0 UnitedHealthcare Dual

Complete ONE (HMO

SNP)

HMO Select counties in Arizona AZ 2,866 Dual-Eligible FIDE SNP

H0423 METROPLUS HEALTH PLAN, INC. Local CCP 001 0 MetroPlus Advantage

Plan (HMO SNP)

HMO NYC - The Bronx, Brooklyn,

Manhattan, Queens

NY 7,630 Dual-Eligible

H0432 UNITEDHEALTHCARE OF ALABAMA,

INC.


Complete (HMO SNP)

HMO Select Counties in Alabama AL 2,896 Dual-Eligible

H0439 CIGNA HEALTHCARE OF GEORGIA,

INC.


TotalCare (HMO SNP)

HMO Select Georgia Counties GA 4,614 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H0490 MOLINA HEALTHCARE OF OHIO, INC. Local CCP 004 0 Molina Medicare

Options Plus (HMO

SNP)

HMO Ohio OH 267 Dual-Eligible

H0524 KAISER FOUNDATION HP, INC. Local CCP 029 0 Senior Advantage

Medicare Medi-Cal

Plan South (HMO

SNP)

HMO Southern California Plan CA 34,234 Dual-Eligible


Medicare Medi-Cal

Plan North (HMO

SNP)

HMO Northern California Plan CA 42,451 Dual-Eligible

H0544 BLUE CROSS OF CALIFORNIA Local CCP 003 0 Anthem Connect

(HMO SNP)

HMO Los Angeles County CA 88 Dual-Eligible

H0544 BLUE CROSS OF CALIFORNIA Local CCP 041 0 Anthem Connect

(HMO SNP)

HMO Santa Clara County CA 13 Dual-Eligible

H0544 BLUE CROSS OF CALIFORNIA Local CCP 052 0 Anthem MediBlue Dual

Advantage (HMO

SNP)

HMO Fresno, Kings, Madera and Tulare

Counties

CA 823 Dual-Eligible


Advantage (HMO

SNP)

HMO Kern County CA 824 Dual-Eligible


Advantage (HMO

SNP)

HMO San Francisco and Sacramento

Counties

CA 6,533 Dual-Eligible


Advantage (HMO

SNP)

HMO Ventura County CA 834 Dual-Eligible

H0562 HEALTH NET OF CALIFORNIA,INC. Local CCP 055 0 Health Net Seniority

Plus Amber I (HMO

SNP)

HMO L.A., Kern, Org, Riv, SB, Fresno,

SD, SF, Tulare



Plus Amber II (HMO

SNP)

HMO Parts of Southern and Northern

California



Plus Amber II (HMO

SNP)


California



Plus Amber II (HMO

SNP)


California


SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H0571 CHINESE COMMUNITY HEALTH PLAN Local CCP 005 0 CCHP Senior Select

Program (HMO SNP)

HMO San Francisco County CA 2,776 Dual-Eligible

H0624 UNITEDHEALTHCARE INSURANCE

COMPANY


Complete (HMO SNP)

HMO Denver and Colorado Springs

metro areas

CO 6,889 Dual-Eligible

H0630 KAISER FOUNDATION HP OF CO Local CCP 014 0 Senior Advantage

Medicare Medicaid

(HMO SNP)

HMO Denver Metro Area CO 3,063 Dual-Eligible

H0712 WELLCARE OF CONNECTICUT, INC. Local CCP 005 0 WellCare Access

(HMO SNP)

HMO Fairfield, Hartford Counties CT 3,311 Dual-Eligible

H0712 WELLCARE OF CONNECTICUT, INC. Local CCP 025 0 WellCare Access

(HMO SNP)

HMO Select Counties in NC NC 126 Dual-Eligible

H0838 UNIVERSAL CARE, INC. Local CCP 024 0 Brand New Day Dual

Coverage (HMO SNP)

HMO KER KIN LA ORA RIV SBD CA 1,015 Dual-Eligible

H0908 BUCKEYE COMMUNITY HEALTH

PLAN, INC.

Local CCP 001 0 Allwell Dual Medicare

(HMO SNP)

HMO Northwest, Northeast, Southwest,

and Eastern Ohio

OH 509 Dual-Eligible

H0913 WELLCARE HEALTH PLANS OF NEW

JERSEY, INC.

Local CCP 013 0 WellCare Liberty (HMO

SNP)

HMO Select Counties in NJ NJ 2,415 Dual-Eligible FIDE SNP

H1019 CAREPLUS HEALTH PLANS, INC. Local CCP 023 0 CareNeeds PLUS

(HMO SNP)

HMO Broward and Palm Beach counties FL 2,696 Dual-Eligible


(HMO SNP)

HMO Miami-Dade County FL 9,050 Dual-Eligible


(HMO SNP)

HMO Hillsborough, Pasco, Pinellas and

Polk counties

FL 3,319 Dual-Eligible


(HMO SNP)

HMO Select local counties FL 3,617 Dual-Eligible


(HMO SNP)

HMO Duval County FL 250 Dual-Eligible

H1019 CAREPLUS HEALTH PLANS, INC. Local CCP 077 0 CareNeeds (HMO

SNP)

HMO Select local counties FL 9,572 Dual-Eligible


SNP)

HMO Hillsborough, Pasco, Pinellas and

Polk counties



SNP)

HMO Broward and Palm Beach counties FL 5,371 Dual-Eligible


SNP)



SNP)

HMO Duval County FL 998 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



(HMO SNP)

HMO Brevard and Indian River counties FL 98 Dual-Eligible


SNP)

HMO Brevard and Indian River counties FL 460 Dual-Eligible

H1026 HEALTH OPTIONS, INC. Local CCP 063 0 BlueMedicare

Complete (HMO SNP)

HMO Miami-Dade County FL 183 Dual-Eligible


Complete (HMO SNP)

HMO Broward County FL 83 Dual-Eligible


Complete (HMO SNP)

HMO Orange County FL 69 Dual-Eligible


Complete (HMO SNP)

HMO Polk County FL 11 Dual-Eligible

H1032 WELLCARE OF FLORIDA, INC. Local CCP 061 0 WellCare Select (HMO

SNP)

HMO Select Counties in FL FL 3,705 Dual-Eligible

H1032 WELLCARE OF FLORIDA, INC. Local CCP 124 0 WellCare Access

(HMO SNP)


H1032 WELLCARE OF FLORIDA, INC. Local CCP 170 0 WellCare Access

(HMO SNP)


H1032 WELLCARE OF FLORIDA, INC. Local CCP 175 0 WellCare Liberty (HMO

SNP)


H1032 WELLCARE OF FLORIDA, INC. Local CCP 176 0 WellCare Liberty (HMO

SNP)


H1032 WELLCARE OF FLORIDA, INC. Local CCP 182 0 WellCare Select (HMO

SNP)


H1036 HUMANA MEDICAL PLAN, INC. Local CCP 077 0 Humana Gold Plus

SNP-DE H1036-077A

(HMO SNP)



SNP-DE H1036-102

(HMO SNP)

HMO Tampa Metro Area FL 3,668 Dual-Eligible


SNP-DE H1036-103A

(HMO SNP)

HMO Broward County FL 4,772 Dual-Eligible


SNP-DE H1036-104A

(HMO SNP)

HMO Palm Beach County FL 2,270 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



SNP-DE H1036-167

(HMO SNP)

HMO Charlotte Metro Area NC 3,587 Dual-Eligible


SNP-DE H1036-168

(HMO SNP)

HMO Greensboro / Winston-Salem

Metro Area

NC 2,894 Dual-Eligible


SNP-DE H1036-209

(HMO SNP)

HMO Flagler and Volusia counties FL 1,071 Dual-Eligible


SNP-DE H1036-210

(HMO SNP)

HMO Jacksonville Area FL 861 Dual-Eligible


SNP-DE H1036-213

(HMO SNP)


counties



SNP-DE H1036-214

(HMO SNP)

HMO Select Counties in Florida FL 764 Dual-Eligible


SNP-DE H1036-222

(HMO SNP)

HMO Select Counties in Mississippi MS 3,415 Dual-Eligible


SNP-DE H1036-226

(HMO SNP)

HMO Glades, Martin, Okeechobee and

St. Lucie counties

FL 586 Dual-Eligible


SNP-DE H1036-231

(HMO SNP)

HMO Hardee, Highlands and Polk

counties


H1036 HUMANA MEDICAL PLAN, INC. Local CCP 235 0 Humana Community

HMO SNP-DE (HMO

SNP)

HMO Jefferson County KY 267 Dual-Eligible


SNP-DE H1036-241

(HMO SNP)

HMO Flagler and Volusia counties FL 3,997 Dual-Eligible


SNP-DE H1036-243

(HMO SNP)

HMO Jacksonville Area FL 3,356 Dual-Eligible


SNP-DE H1036-245

(HMO SNP)

HMO Select Counties in Florida FL 1,762 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



SNP-DE H1036-247

(HMO SNP)


counties



SNP-DE H1036-249

(HMO SNP)

HMO Glades, Martin, Okeechobee and

St. Lucie counties



SNP-DE H1036-251

(HMO SNP)

HMO Tampa Metro Area FL 10,851 Dual-Eligible


SNP-DE H1036-253

(HMO SNP)

HMO Hardee, Highlands and Polk

counties



SNP-DE H1036-255

(HMO SNP)

HMO Broward County FL 6,126 Dual-Eligible


SNP-DE H1036-257

(HMO SNP)



SNP-DE H1036-259

(HMO SNP)

HMO Palm Beach County FL 4,223 Dual-Eligible


SNP-DE H1036-261

(HMO SNP)

HMO Sarasota County FL 57 Dual-Eligible


SNP-DE H1036-262

(HMO SNP)

HMO Sarasota County FL 205 Dual-Eligible

H1045 PREFERRED CARE PARTNERS, INC. Local CCP 012 0 Preferred Medicare

Assist (HMO SNP)

HMO Miami-Dade and Broward

Counties


H1045 PREFERRED CARE PARTNERS, INC. Local CCP 038 0 Preferred Medicare

Assist Palm Beach

(HMO SNP)

HMO Palm Beach county FL 912 Dual-Eligible

H1045 PREFERRED CARE PARTNERS, INC. Local CCP 039 0 UnitedHealthcare Dual

Complete LP (HMO

SNP)

HMO Select counties in Central Florida FL 3,081 Dual-Eligible

H1045 PREFERRED CARE PARTNERS, INC. Local CCP 040 0 UnitedHealthcare Dual

Complete LP (HMO

SNP)

HMO Select counties in Florida FL 1,380 Dual-Eligible

H1112 WELLCARE OF GEORGIA, INC. Local CCP 006 0 WellCare Access

(HMO SNP)

HMO Select Counties in GA GA 15,346 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H1112 WELLCARE OF GEORGIA, INC. Local CCP 033 0 WellCare Liberty (HMO

SNP)

HMO Select Counties in GA GA 2,810 Dual-Eligible

H1170 KAISER FOUNDATION HP OF GA, INC. Local CCP 008 0 Senior Advantage

Medicare Medicaid

Plan (HMO SNP)

HMO Atlanta Metro Area GA 1,168 Dual-Eligible


Medicare Medicaid

(HMO SNP)

HMO Islands of Oahu and Maui HI 435 Dual-Eligible

H1264 WELLCARE OF TEXAS, INC. Local CCP 007 0 WellCare Access

(HMO SNP)

HMO Select Counties in TX TX 11,134 Dual-Eligible

H1264 WELLCARE OF TEXAS, INC. Local CCP 020 0 WellCare Liberty (HMO

SNP)

HMO Select counties in TX TX 1,984 Dual-Eligible

H1264 WELLCARE OF TEXAS, INC. Local CCP 021 0 WellCare Liberty (HMO

SNP)

HMO Select Counties in TX TX 716 Dual-Eligible

H1350 BLUE CROSS OF IDAHO CARE PLUS,

INC.

Local CCP 009 0 True Blue Special

Needs Plan (HMO

SNP)

HMO Select Counties in Idaho ID 3,015 Dual-Eligible FIDE SNP

H1416 HARMONY HEALTH PLAN, INC. Local CCP 033 0 WellCare Access

(HMO SNP)

HMO Select Counties in AR AR 4,464 Dual-Eligible


(HMO SNP)

HMO Select Counties in MS MS 11,204 Dual-Eligible


(HMO SNP)

HMO Select Counties in TN TN 4,946 Dual-Eligible


(HMO SNP)

HMO Select Counties in SC SC 2,731 Dual-Eligible

H1416 HARMONY HEALTH PLAN, INC. Local CCP 043 0 WellCare Liberty (HMO

SNP)

HMO Select Counties in AR AR 1,305 Dual-Eligible

H1416 HARMONY HEALTH PLAN, INC. Local CCP 044 0 WellCare Liberty (HMO

SNP)

HMO Select Counties in MS MS 1,729 Dual-Eligible

H1436 ABSOLUTE TOTAL CARE, INC. Local CCP 005 0 Allwell Dual Medicare

(HMO SNP)

HMO Abbeville, Chesterfield,

Georgetown, Beaufort

SC 123 Dual-Eligible

H1436 ABSOLUTE TOTAL CARE, INC. Local CCP 006 0 Allwell Dual Medicare

Essentials (HMO SNP)

HMO Abbeville, Chesterfield,

Georgetown, Beaufort

SC 29 Dual-Eligible

H1587 ARKANSAS SUPERIOR SELECT, INC. Local CCP 001 0 Tribute (HMO-POS

SNP)

HMOPOS Arkansas AR 1,030 Dual-Eligible

H1609 AETNA HEALTH INC. (FL) Local CCP 015 0 Coventry Medicare

Vista Plan (HMO SNP)

HMO South FL FL 735 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



Summit Plan (HMO

SNP)

HMO South FL FL 13,577 Dual-Eligible


Summit Plan (HMO

SNP)

HMO South FL, Treasure Coast FL,

West FL


H1609 AETNA HEALTH INC. (FL) Local CCP 023 0 Aetna Medicare Select

Plan (HMO SNP)

HMO Central FL FL 492 Dual-Eligible

H1610 COVENTRY HEALTH CARE OF

VIRGINIA

Local CCP 001 0 Aetna Better Health,

Inc. (VA) (HMO SNP)

HMO Virginia VA 455 Dual-Eligible

H1894 AMERIGROUP WASHINGTON, INC. Local CCP 002 0 Amerivantage Dual

Coordination (HMO

SNP)

HMO King and Snohomish Counties WA 158 Dual-Eligible


LOUISIANA, INC.


SNP-DE H1951-032

(HMO SNP)

HMO Baton Rouge Area LA 3,188 Dual-Eligible


LOUISIANA, INC.


SNP-DE H1951-033

(HMO SNP)

HMO New Orleans Area LA 4,394 Dual-Eligible


LOUISIANA, INC.


SNP-DE H1951-034

(HMO SNP)

HMO Washington and St. Tammany

Parishes

LA 1,013 Dual-Eligible


LOUISIANA, INC.


SNP-DE H1951-041

(HMO SNP)

HMO Select Louisiana Parishes LA 6,217 Dual-Eligible

H1961 PEOPLES HEALTH, INC. Local CCP 003 0 Peoples Health Secure

Health (HMO SNP)

HMO South Louisiana LA 19,062 Dual-Eligible

H1961 PEOPLES HEALTH, INC. Local CCP 011 0 Peoples Health Secure

Choice #011 (HMO

SNP)

HMO North and Central Louisiana LA 28 Dual-Eligible

H2034 COMMUNITY CARE HEALTH PLAN,

INC.

Local CCP 001 0 Community Care's

Partnership Program

(HMO SNP)

HMO Eastern Wisconsin WI 370 Dual-Eligible FIDE SNP

H2034 COMMUNITY CARE HEALTH PLAN,

INC.

Local CCP 002 0 Community Care's

Partnership Program

Disabled (HMO SNP)

HMO Eastern Wisconsin WI 108 Dual-Eligible FIDE SNP

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



TotalCare (HMO SNP)

HMO Maryland, Washington DC and

Delaware Counties

DC; DE; MD 4,355 Dual-Eligible

H2168 VILLAGE SENIOR SERVICES

CORPORATION

Local CCP 001 0 VillageCareMAX

Medicare Health

Advantage (HMO-POS

SNP)

HMOPOS Bronx, Kings, New York, Queens NY 157 Dual-Eligible

H2168 VILLAGE SENIOR SERVICES

CORPORATION

Local CCP 002 0 VillageCareMAX

Medicare Total

Advantage (HMO-POS

SNP)

HMOPOS Bronx, Kings, New York, Queens NY 384 Dual-Eligible FIDE SNP

H2174 TRILLIUM COMMUNITY HEALTH PLAN Local CCP 001 0 Trillium Advantage

Dual (HMO SNP)

HMO Lane County OR 2,661 Dual-Eligible

H2224 SENIOR WHOLE HEALTH, LLC Local CCP 001 0 Senior Whole Health

(HMO SNP)

HMO Brstl, Essx, Hmpdn, Mdlsx, Nrflk,

Plmth, Sflk, Wor

MA 7,644 Dual-Eligible FIDE SNP

H2224 SENIOR WHOLE HEALTH, LLC Local CCP 003 0 Senior Whole Health

NHC (HMO SNP)

HMO Brstl, Essx, Hmpdn, Mdlsx, Nrflk,

Plmth, Sflk, Wor


H2225 COMMONWEALTH CARE ALLIANCE,

INC.

Local CCP 001 0 Senior Care Options

Program (HMO SNP)

HMO BRI, ESS, FRA, HMD, HMP, MID,

NOR, PLY, SUF, WOR



COMPANY


Senior Care Options

(HMO SNP)

HMO Boston, Springfield and Worcester

Metro Areas



COMPANY


Complete (PPO SNP)

Local PPO El Paso County TX 12,073 Dual-Eligible


COMPANY


Complete (PPO SNP)

Local PPO Dona Ana, Grant, Hidalgo, Luna

and Sierra counties

NM 6,092 Dual-Eligible


COMPANY


Complete (PPO SNP)

Local PPO Honolulu County HI 11,013 Dual-Eligible


COMPANY


Complete (PPO SNP)

Local PPO Atlanta and Macon Metro Areas GA 10,669 Dual-Eligible


COMPANY


Complete (PPO SNP)

Local PPO Washington, DC DC 6,980 Dual-Eligible


COMPANY


Complete (PPO SNP)

Local PPO Bernalillo, Sandoval, Santa Fe,

Valencia Counties

NM 9,248 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H2237 INDEPENDENT CARE HEALTH PLAN,

INC.

Local CCP 001 0 iCare Medicare Plan

(HMO SNP)

HMO Eastern, South Central and

Western Wisconsin

WI 6,801 Dual-Eligible


INC.

Local CCP 007 0 iCare Family Care

Partnership (HMO

SNP)

HMO Milwaukee, Racine, Kenosha and

Dane Counties

WI 625 Dual-Eligible FIDE SNP


INC.

Local CCP 009 0 Aurora Special Needs

Plan (HMO SNP)

HMO Milwaukee, Waukesha and SE

Wis. Counties

WI 288 Dual-Eligible


INC.

Local CCP 010 0 Lakeland Care +Health

(HMO SNP)

HMO Northeast Wisconsin WI 22 Dual-Eligible

H2247 UNITEDHEALTHCARE COMMUNITY

PLAN, INC.


Complete (HMO SNP)

HMO Select Counties in MI MI 437 Dual-Eligible

H2256 TUFTS ASSOCIATED HEALTH

MAINTENANCE ORGANIZATION

Local CCP 029 0 Tufts Health Plan

Senior Care Options

(HMO SNP)

HMO Most of Massachusetts MA 3,734 Dual-Eligible FIDE SNP

H2416 PRIMEWEST RURAL MN HEALTH

CARE ACCESS INITIATIVE

Local CCP 001 0 PrimeWest Senior

Health Complete

(HMO SNP)

HMO Northern, west central, and

southwestern Minnesota

MN 1,928 Dual-Eligible FIDE SNP

H2417 ITASCA MEDICAL CARE Local CCP 001 0 IMCare Classic (HMO

SNP)

HMO Itasca County MN 457 Dual-Eligible FIDE SNP

H2419 SOUTH COUNTRY HEALTH ALLIANCE Local CCP 001 0 SeniorCare Complete

(HMO SNP)

HMO Select Counties in Minnesota MN 1,818 Dual-Eligible FIDE SNP

H2422 HEALTHPARTNERS, INC. Local CCP 002 0 HealthPartners

Minnesota Senior

Health Options (HMO

SNP)

HMO Minneapolis/St. Paul Metro Area MN 3,198 Dual-Eligible FIDE SNP

H2425 BLUE PLUS Local CCP 001 0 SecureBlue (HMO)

SNP (HMO SNP)

HMO 62 Counties within the State of

Minnesota


H2456 UCARE MINNESOTA Local CCP 002 0 UCare's Minnesota

Senior Health Options

(HMO SNP)

HMO Twin Cities Metropolitan area and

Greater MN


H2458 MEDICA HEALTH PLANS Local CCP 002 0 Medica DUAL Solution

(HMO SNP)

HMO Specific Minnesota Counties MN 10,945 Dual-Eligible FIDE SNP

H2491 WELLCARE HEALTH INSURANCE OF

ARIZONA, INC.

Local CCP 004 0 'Ohana Liberty (HMO

SNP)

HMO Hawaii, Honolulu, Kauai, Maui

Counties

HI 4,923 Dual-Eligible


ARIZONA, INC.

Local CCP 006 0 WellCare Access

(HMO SNP)

HMO Select Counties in LA LA 6,627 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



ARIZONA, INC.


SNP)

HMO Select Counties in LA LA 2,775 Dual-Eligible

H2563 OPTIMA HEALTH PLAN Local CCP 004 0 Optima Community

Complete (HMO SNP)

HMO Virginia VA 45 Dual-Eligible

H2649 HUMANA HEALTH PLAN, INC. Local CCP 028 0 Humana Gold Plus

SNP-DE H2649-028

(HMO SNP)

HMO Select counties in Missouri MO 2,239 Dual-Eligible


SNP-DE H2649-048

(HMO SNP)

HMO Select Counties in Texas TX 4,673 Dual-Eligible


SNP-DE H2649-050

(HMO SNP)

HMO Corpus Christi/San Antonio area TX 2,076 Dual-Eligible


YORK, INC.

Local CCP 018 0 Advantage Value One

NY - Dual (HMO SNP)

HMO Nassau, Queens, Staten Island

and Suffolk Counties

NY 35 Dual-Eligible


MIDLANDS, INC.


Complete (HMO SNP)

HMO Select Counties in Alabama AL 15,034 Dual-Eligible

H2879 MOLINA HEALTHCARE OF

WISCONSIN

Local CCP 001 0 Molina Medicare

Options Plus (HMO

SNP)

HMO Milwaukee WI 1,025 Dual-Eligible

H2915 PENNSYLVANIA HEALTH &

WELLNESS, INC.


(HMO SNP)

HMO Southwestern Zone PA 44 Dual-Eligible

H2915 PENNSYLVANIA HEALTH &

WELLNESS, INC.


(HMO SNP)

HMO Southeastern Zone PA Dual-Eligible

H2926 PRIMEWEST RURAL MN HEALTH

CARE ACCESS INITIATIVE

Local CCP 001 0 Prime Health

Complete (HMO SNP)

HMO Northern, west central, and

southwestern Minnesota

MN 198 Dual-Eligible FIDE SNP

H3054 CONSTELLATION HEALTH, LLC. Local CCP 001 0 Genesis Constellation

Health (HMO SNP)

HMO Puerto Rico PR 4,547 Dual-Eligible PBP A Platino YN

H3054 CONSTELLATION HEALTH, LLC. Local CCP 003 0 Genesis Prime

Constellation Health

(HMO SNP)


H3054 CONSTELLATION HEALTH, LLC. Local CCP 004 0 Genesis @ Home

Constellation Health

(HMO SNP)

HMO Puerto Rico PR 452 Dual-Eligible PBP A Platino YN

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H3113 OXFORD HEALTH PLANS (NJ), INC. Local CCP 005 0 UnitedHealthcare Dual

Complete ONE (HMO

SNP)

HMO Select counties in New Jersey NJ 18,170 Dual-Eligible FIDE SNP


Complete (HMO SNP)

HMO Select counties in Pennsylvania PA 10,872 Dual-Eligible


Complete (HMO SNP)

HMO Select counties in Rhode Island RI 2,362 Dual-Eligible


Complete (HMO SNP)

HMO New Castle County DE 1,604 Dual-Eligible


Complete ONE (HMO

SNP)

HMO Select Counties in Pennsylvania PA 50 Dual-Eligible

H3204 PRESBYTERIAN HEALTH PLAN Local CCP 012 0 Presbyterian Dual Plus

(HMO SNP)

HMO Bernalilo, Sandoval, Torrance,

Valencia

NM 238 Dual-Eligible

H3227 ERIENIAGARA MLTC Local CCP 001 0 Kalos Health Gold Plus

(HMO SNP)

HMO Western New York NY 25 Dual-Eligible

H3233 PREMIER HEALTH INSURING

CORPORATION

Local CCP 002 0 Premier Health

Advantage VIP (HMO

SNP)

HMO Dayton Metro OH Dual-Eligible

H3240 AMERIGROUP NEW JERSEY, INC. Local CCP 013 0 Amerivantage Dual

Coordination (HMO

SNP)

HMO Eastern and Central New Jersey NJ 8,681 Dual-Eligible FIDE SNP

H3240 AMERIGROUP NEW JERSEY, INC. Local CCP 016 0 Amerivantage Dual

Coordination (HMO

SNP)

HMO Select Counties in New Jersey NJ 718 Dual-Eligible FIDE SNP

H3259 VOLUNTEER STATE HEALTH PLAN Local CCP 001 0 BlueCare Plus (HMO

SNP)

HMO Tennessee TN 15,298 Dual-Eligible

H3291 PRUITTHEALTH PREMIER, INC. Local CCP 002 0 PruittHealth Premier D-

SNP (HMO SNP)

HMO GA (Clarke County) GA Dual-Eligible

H3328 THE NEW YORK STATE CATHOLIC

HEALTH PLAN, INC.

Local CCP 002 0 Fidelis Dual Advantage

(HMO SNP)

HMO NY Counties NY 1,363 Dual-Eligible


HEALTH PLAN, INC.

Local CCP 016 0 Fidelis Medicaid

Advantage Plus (HMO

SNP)

HMO NY Counties NY 99 Dual-Eligible FIDE SNP


HEALTH PLAN, INC.

Local CCP 017 0 Fidelis Dual Advantage

Flex (HMO SNP)

HMO NY Counties NY 33,418 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H3330 HEALTH INSURANCE PLAN OF

GREATER NEW YORK

Local CCP 037 0 EmblemHealth VIP

Dual (HMO SNP)

HMO NYC, Westchester, Long Island,

Orange, Rockland


H3330 HEALTH INSURANCE PLAN OF

GREATER NEW YORK

Local CCP 818 0 EmblemHealth VIP

Dual Group (HMO

SNP)

HMO NYC, Westchester, Long Island,

Orange and Rockland

NY 105 Dual-Eligible

H3347 ELDERPLAN, INC. Local CCP 002 0 Elderplan For Medicaid

Beneficiaries (HMO

SNP)

HMO Brx, Ki, Na, NY, Qu, Wes NY 4,320 Dual-Eligible

H3347 ELDERPLAN, INC. Local CCP 007 0 Elderplan Plus Long

Term Care (HMO

SNP)

HMO Brx, Ki, Na, NY, Qu, Ri, Wes NY 1,385 Dual-Eligible FIDE SNP

H3359 HEALTHFIRST HEALTH PLAN, INC. Local CCP 021 0 Healthfirst Life

Improvement Plan

(HMO SNP)

HMO New York City, Nassau and

Westchester Counties


H3359 HEALTHFIRST HEALTH PLAN, INC. Local CCP 034 0 Healthfirst

CompleteCare (HMO

SNP)

HMO New York City, Nassau, and

Westchester Counties

NY 6,336 Dual-Eligible FIDE SNP

H3361 WELLCARE OF NEW YORK, INC. Local CCP 043 0 WellCare Liberty (HMO

SNP)

HMO Select Counties in NY NY 2,104 Dual-Eligible

H3361 WELLCARE OF NEW YORK, INC. Local CCP 065 0 WellCare Access

(HMO SNP)


H3361 WELLCARE OF NEW YORK, INC. Local CCP 109 0 WellCare Access

(HMO SNP)


H3387 UNITEDHEALTHCARE OF NEW YORK,

INC.


Complete (HMO SNP)

HMO Select counties in New York NY 76,316 Dual-Eligible

H3447 HEALTHKEEPERS, INC. Local CCP 011 0 Anthem MediBlue Dual

Advantage (HMO

SNP)

HMO Select Counties in Virginia VA 2,145 Dual-Eligible

H3447 HEALTHKEEPERS, INC. Local CCP 012 0 Anthem MediBlue Dual

Advantage (HMO

SNP)

HMO Select Counties in Virginia VA 1,219 Dual-Eligible

H3533 HUMANA HEALTH COMPANY OF NEW

YORK, INC.


SNP-DE H3533-002

(HMO SNP)

HMO Select Counties in New York NY 1,394 Dual-Eligible

H3533 HUMANA HEALTH COMPANY OF NEW

YORK, INC.


SNP-DE H3533-004

(HMO SNP)

HMO Select Counties in New York NY 1,000 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H3561 HEALTH NET COMMUNITY

SOLUTIONS, INC.

Local CCP 001 0 Health Net Seniority

Plus Amber II Premier

(HMO SNP)

HMO Fresno County CA 126 Dual-Eligible

H3655 COMMUNITY INSURANCE COMPANY Local CCP 033 0 Anthem MediBlue Dual

Advantage (HMO

SNP)

HMO Select Counties in Ohio OH 13,643 Dual-Eligible

H3672 THE HEALTH PLAN OF WEST

VIRGINIA

Local CCP 019 0 The Health Plan

SecureCare SNP

(HMO SNP)

HMO Southeastern Ohio, West Virginia OH; WV 1,936 Dual-Eligible




Complete LP1 (HMO

SNP)

HMO Select Counties in Wisconsin WI 6,347 Dual-Eligible

H3811 SAMARITAN HEALTH PLANS, INC. Local CCP 003 0 Samaritan Advantage

Special Needs Plan

(HMO SNP)

HMO Benton, Linn and Lincoln counties OR 1,526 Dual-Eligible

H3814 ATRIO HEALTH PLANS Local CCP 007 0 ATRIO Special Needs

Plan (HMO SNP)

HMO Douglas and Klamath Counties OR 2,075 Dual-Eligible


Plan (Rogue) (HMO

SNP)

HMO Josephine and Jackson Counties OR 299 Dual-Eligible

H3818 FAMILYCARE HEALTH PLANS, INC. Local CCP 002 0 FamilyCare

Community (HMO

SNP)

HMO Portland Metro and Clatsop

Counties

OR 1,644 Dual-Eligible

H3822 HEALTH CARE SERVICE

CORPORATION

Local CCP 006 0 Blue Cross Medicare

Advantage Dual Care

(HMO SNP)

HMO Bernalillo, Sandoval, Torrance and

Valencia

NM 407 Dual-Eligible

H3832 HAWAII MEDICAL SERVICE

ASSOCIATION

Local CCP 011 0 HMSA Akamai

Advantage Dual Care

(PPO SNP)

Local PPO Hawaii, Kalawao, Kauai, Maui and

Honolulu counties

HI 242 Dual-Eligible


TotalCare (HMO SNP)

HMO Select Pennsylvania Counties PA 17,037 Dual-Eligible

H3954 GEISINGER HEALTH PLAN Local CCP 097 0 Geisinger Gold Secure

Rx (HMO SNP)

HMO Pennsylvania PA 8,208 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H3959 AETNA HEALTH INC. (PA) Local CCP 035 0 Advantra Cares (HMO

SNP)

HMO Southeastern Pennsylvania PA 732 Dual-Eligible

H3959 AETNA HEALTH INC. (PA) Local CCP 036 0 Advantra Cares (HMO

SNP)

HMO Central and Western Pennsylvania PA 1,539 Dual-Eligible

H4003 MMM HEALTHCARE, LLC Local CCP 017 0 MMM - Diamante

Choice Platino (HMO

SNP)



Excel Platino (HMO

SNP)



Choice Plus Platino

(HMO SNP)


H4004 MMM HEALTHCARE, LLC Local CCP 048 0 PMC - Premier

Preferred Platino

(HMO SNP)

HMO PUERTO RICO PR 12,828 Dual-Eligible PBP A Platino YN


Excel Plus Platino

(HMO SNP)


H4007 HUMANA HEALTH PLANS OF PUERTO

RICO, INC.


SNP-DE H4007-016

(HMO SNP)

HMO Puerto Rico Island Wide PR 12,007 Dual-Eligible PBP A Platino YN

H4007 HUMANA HEALTH PLANS OF PUERTO

RICO, INC.


SNP-DE H4007-018

(HMO SNP)

HMO Puerto Rico Island Wide PR 11,395 Dual-Eligible PBP A Platino YN

H4091 SIMPRA ADVANTAGE, INC. Local CCP 002 0 Simpra Advantage

(PPO SNP)

Local PPO Alabama statewide AL Dual-Eligible

H4141 HUMANA EMPLOYERS HEALTH PLAN

OF GEORGIA, INC.


SNP-DE H4141-003

(HMO SNP)

HMO Greater Georgia Area GA 5,025 Dual-Eligible

H4227 VISTA HEALTH PLAN, INC. Local CCP 001 0 Keystone First VIP

Choice (HMO SNP)

HMO Eastern Pennsylvania PA 5,732 Dual-Eligible

H4227 VISTA HEALTH PLAN, INC. Local CCP 002 0 AmeriHealth Caritas

VIP Care (HMO SNP)

HMO Eastern Pennsylvania PA 387 Dual-Eligible

H4227 VISTA HEALTH PLAN, INC. Local CCP 003 0 AmeriHealth Caritas

VIP Care (HMO SNP)

HMO Western Pennsylvania PA Dual-Eligible

H4279 UPMC FOR YOU, INC Local CCP 001 0 UPMC for Life Dual

(HMO SNP)

HMO Pennsylvania PA 25,785 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H4346 HMO COLORADO, INC. Local CCP 014 0 Anthem MediBlue Dual

Advantage (HMO

SNP)

HMO Greater Denver Area CO 476 Dual-Eligible

H4407 HEALTHSPRING OF TENNESSEE,

INC.


TotalCare SMS (HMO

SNP)

HMO Select Mississippi Counties MS 2,262 Dual-Eligible


INC.


TotalCare (HMO SNP)

HMO Middle and West Tennessee TN 7,420 Dual-Eligible


INC.


TotalCare AR (HMO

SNP)

HMO Select Arkansas Counties AR 92 Dual-Eligible


INC.


TotalCare ETN (HMO

SNP)

HMO East Tennessee TN 220 Dual-Eligible

H4461 CARITEN HEALTH PLAN INC. Local CCP 022 0 Humana Gold Plus

SNP-DE H4461-022

(HMO SNP)

HMO Greater Tennessee TN 6,982 Dual-Eligible

H4513 HEALTHSPRING LIFE & HEALTH



TotalCare (HMO SNP)

HMO Texas HealthSpring Counties TX 22,270 Dual-Eligible




TotalCare (HMO SNP)

HMO North Texas TX 396 Dual-Eligible




TotalCare (HMO SNP)

HMO Select Texas Counties TX 1,921 Dual-Eligible

H4514 UNITEDHEALTHCARE COMMUNITY

PLAN OF TEXAS, L.L.C.


Complete (HMO SNP)

HMO Houston and Austin Metro areas TX 23,571 Dual-Eligible

H4527 PHYSICIANS HEALTH CHOICE OF

TEXAS, LLC


Complete Focus (HMO

SNP)

HMO Hays, Travis, and Williamson

counties

TX 1,488 Dual-Eligible


TEXAS, LLC


Complete Focus (HMO

SNP)

HMO Aransas, Kleberg, Nueces, San

Patricio counties



TEXAS, LLC


Complete Focus (HMO

SNP)

HMO El Paso County TX 438 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



TEXAS, LLC


Complete Focus (HMO

SNP)

HMO Cameron, Hidalgo, and Willacy

counties



TEXAS, INC.


Complete (HMO SNP)

HMO Dallas/Ft Worth Metroplex TX 15,948 Dual-Eligible


TEXAS, INC.


Complete (HMO SNP)

HMO San Antonio Metro area TX 11,452 Dual-Eligible


TEXAS, INC.


Complete (HMO SNP)

HMO Corpus Christi metro area TX 6,235 Dual-Eligible

H4922 AGEWELL NEW YORK, LLC Local CCP 002 0 AgeWell New York

BeWell (HMO SNP)

HMO New York City Metro Area, Long

Island, Westchester



FeelWell (HMO SNP)


Island, Westchester


H4931 UNIVERSITY CARE ADVANTAGE, INC. Local CCP 001 0 University Care

Advantage (HMO

SNP)

HMO Cochise, Gila, Graham, Greenlee,

La Paz

AZ 1,193 Dual-Eligible


Advantage (HMO

SNP)

HMO Pima County AZ 3,121 Dual-Eligible


Advantage (HMO

SNP)

HMO Pinal County AZ 1,671 Dual-Eligible


Advantage (HMO

SNP)

HMO Santa Cruz, Yavapai, Yuma AZ 2,333 Dual-Eligible


Advantage (HMO

SNP)

HMO ALTCS: Cochise, Gila, Graham,

Greenlee, La Paz

AZ 173 Dual-Eligible FIDE SNP


Advantage (HMO

SNP)

HMO ALTCS: Pima AZ 315 Dual-Eligible FIDE SNP


Advantage (HMO

SNP)

HMO ALTCS: Maricopa, Pinal AZ 899 Dual-Eligible FIDE SNP


Advantage (HMO

SNP)

HMO ALTCS: Santa Cruz, Yuma AZ 156 Dual-Eligible FIDE SNP

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



COMPANY


Complete (HMO SNP)

HMO Select Counties in Washington WA 25,210 Dual-Eligible


COMPANY


Complete (HMO-POS

SNP)

HMOPOS Select counties in New Mexico NM 3,475 Dual-Eligible


COMPANY


Complete (HMO SNP)

HMO New Orleans Metro area LA 3,334 Dual-Eligible


COMPANY


Complete (HMO SNP)

HMO Select Counties in Mississippi MS 1,500 Dual-Eligible


COMPANY


Complete (HMO SNP)

HMO Gila county AZ 47 Dual-Eligible

H5087 EASY CHOICE HEALTH PLAN INC. Local CCP 001 0 Easy Choice Freedom

Plan (HMO SNP)

HMO Los Angeles County CA 5,867 Dual-Eligible

H5190 SUNSHINE STATE HEALTH PLAN,

INC.


(HMO SNP)

HMO 9 Counties in Central and North

Florida



INC.


(HMO SNP)

HMO 8 Counties in Central and North

Florida



INC.


(HMO SNP)

HMO Broward and Palm Beach

Counties



INC.


(HMO SNP)


H5209 CARE WISCONSIN HEALTH PLAN,

INC.

Local CCP 002 0 Partnership (HMO

SNP)

HMO Southcentral and Eastern

Wisconsin

WI 1,509 Dual-Eligible FIDE SNP

H5209 CARE WISCONSIN HEALTH PLAN,

INC.

Local CCP 004 0 Care Wisconsin

Medicare Dual

Advantage (HMO

SNP)

HMO Southern, Central and

Northeastern Wisconsin

WI 279 Dual-Eligible

H5211 SECURITY HEALTH PLAN OF

WISCONSIN, INC.

Local CCP 010 0 Ally Rx (HMO SNP) HMO Central Wisconsin WI 349 Dual-Eligible

H5215 NETWORK HEALTH INSURANCE

CORPORATION

Local CCP 007 0 NetworkCares (PPO

SNP)

Local PPO East Central Wisconsin WI 2,663 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H5253 UNITEDHEALTHCARE OF

WISCONSIN, INC.


Complete LP (HMO

SNP)

HMO Select counties in Wisconsin WI 9,426 Dual-Eligible


WISCONSIN, INC.


Complete (HMO SNP)

HMO Select Counties in North Carolina NC 18,562 Dual-Eligible


WISCONSIN, INC.


Complete (HMO SNP)

HMO Select Counties in Ohio OH 12,474 Dual-Eligible

H5294 SUPERIOR HEALTH PLAN, INC. Local CCP 002 1 Allwell Dual Medicare

(HMO SNP)

HMO Bex, Coll, Cam, Dall, Hidalgo,

Nueces, Rock, Tarr

TX 51 Dual-Eligible


(HMO SNP)


Nueces, Rock, Tarr



(HMO SNP)


Nueces, Rock, Tarr

TX 73 Dual-Eligible


(HMO SNP)


Nueces, Rock, Tarr


H5322 CARE IMPROVEMENT PLUS SOUTH



Complete (HMO SNP)

HMO Hardin, Harrison, McLennan,

Orange, Rusk counties





Complete (HMO SNP)

HMO Cameron, Hidalgo, and Willacy

Counties





Complete (HMO-POS

SNP)

HMOPOS Select Counties in Ohio OH 4,840 Dual-Eligible




Complete (HMO-POS

SNP)

HMOPOS Johnson, Sedgwick, and

Wyandotte Counties

KS 2,720 Dual-Eligible




Complete (HMO-POS

SNP)

HMOPOS Select Counties in Georgia GA 2,021 Dual-Eligible




Complete (HMO SNP)

HMO Select Counites in OK OK 1,780 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H5410 HEALTHSPRING OF FLORIDA Local CCP 013 0 Cigna-HealthSpring

TotalCare (HMO SNP)

HMO Northern Florida FL 1,139 Dual-Eligible

H5420 MEDICA HEALTHCARE PLANS, INC. Local CCP 006 0 Medica HealthCare

Plans MedicareMax

Plus (HMO SNP)

HMO Miami-Dade and Broward County FL 9,346 Dual-Eligible

H5422 BLUE CROSS BLUE SHIELD

HEALTHCARE PLAN OF GEORGIA

Local CCP 007 0 BCBSHP MediBlue

Dual Advantage (HMO

SNP)

HMO Select Counties in Georgia GA 1,329 Dual-Eligible

H5425 SCAN HEALTH PLAN Local CCP 010 0 SCAN Connections

(HMO SNP)

HMO Los Angeles, Riverside and San

Bernardino Counties

CA 11,259 Dual-Eligible FIDE SNP

H5425 SCAN HEALTH PLAN Local CCP 029 0 SCAN Connections at

Home (HMO SNP)

HMO Los Angeles County CA 1,605 Dual-Eligible FIDE SNP


Home (HMO SNP)

HMO Riverside County CA 542 Dual-Eligible FIDE SNP


Home (HMO SNP)

HMO San Bernardino County CA 334 Dual-Eligible FIDE SNP

H5427 FREEDOM HEALTH, INC. Local CCP 078 0 Freedom Medi-Medi

Partial (HMO SNP)


H5427 FREEDOM HEALTH, INC. Local CCP 087 0 Freedom Medi-Medi

Full (HMO SNP)


H5430 ONECARE BY CARE1ST HEALTH

PLAN ARIZONA INC.

Local CCP 001 0 Care1st+ (HMO SNP) HMO Counties: Maricopa and Pima AZ 2,050 Dual-Eligible

H5433 ORANGE COUNTY HEALTH

AUTHORITY

Local CCP 001 0 OneCare (HMO SNP) HMO Orange County, California CA 1,376 Dual-Eligible

H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 001 0 Simply Complete

(HMO SNP)



(HMO SNP)

HMO Polk County FL 5,778 Dual-Eligible


(HMO SNP)


Counties



(HMO SNP)

HMO Broward County FL 582 Dual-Eligible


(HMO SNP)


Pasco Counties



(HMO SNP)

HMO Palm Beach FL 172 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 060 0 Simply Advantage

(HMO SNP)

HMO Orange, Osceola, Seminole FL 469 Dual-Eligible


(HMO SNP)

HMO Broward FL 166 Dual-Eligible


(HMO SNP)


Pasco Counties



(HMO SNP)

HMO Palm Beach FL 153 Dual-Eligible

H5475 MERIDIAN HEALTH PLAN OF

MICHIGAN, INC.

Local CCP 001 0 MeridianCare Extra

(HMO SNP)

HMO Genesee, Macomb, Saginaw,

Oakland & Wayne Counties

MI 4,058 Dual-Eligible


MICHIGAN, INC.


(HMO SNP)

HMO Barry, Kalamazoo, Kent,

Muskegon, Ottawa Counties



MICHIGAN, INC.


(HMO SNP)

HMO Livingston, Monroe, Washtenaw

Counties

MI 252 Dual-Eligible


MICHIGAN, INC.


(HMO SNP)

HMO Fulton, Henry, Lucas and Wood

Counties

OH 21 Dual-Eligible


MICHIGAN, INC.


(HMO SNP)

HMO Clermont and Hamilton Counties OH Dual-Eligible


MICHIGAN, INC.


(HMO SNP)

HMO Butler County OH Dual-Eligible

H5549 VNS CHOICE Local CCP 002 0 VNSNY CHOICE

Medicare Preferred

(HMO SNP)

HMO NYC Metro Area and Capital

Region


H5549 VNS CHOICE Local CCP 003 0 VNSNY CHOICE Total

(HMO SNP)

HMO New York Metro Area NY 1,420 Dual-Eligible FIDE SNP

H5549 VNS CHOICE Local CCP 006 0 VNSNY CHOICE

Medicare Maximum

(HMO SNP)

HMO New York Metro Area NY 396 Dual-Eligible

H5576 VANTAGE HEALTH PLAN, INC. Local CCP 019 0 AAA7 Vantage Dual

Special Needs Plan

(HMO SNP)

HMO State of Louisiana LA 122 Dual-Eligible

H5577 MCS ADVANTAGE, INC. Local CCP 002 0 MCS Classicare

Platino Ideal (HMO

SNP)



Platino Progreso

(HMO SNP)



Platino Original (HMO

SNP)


SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



Platino C≤modo (HMO

SNP)



Platino Clßsico (HMO

SNP)



Platino MßsCa$h

(HMO SNP)

HMO Puerto Rico - 56 PR 3,333 Dual-Eligible PBP A Platino YN

H5580 SOUTHWEST CATHOLIC HEALTH

NETWORK CORPORATION

Local CCP 001 0 Mercy Care Advantage

(HMO SNP)

HMO Maricopa and Pima Counties AZ 12,594 Dual-Eligible


NETWORK CORPORATION


(HMO SNP)

HMO Maricopa, Gila, Pinal, and Pima

Counties

AZ 5,060 Dual-Eligible FIDE SNP


NETWORK CORPORATION


(HMO SNP)

HMO Maricopa, Pima and Santa Cruz

Counties


H5587 HEALTH CHOICE ARIZONA, INC. Local CCP 002 0 Health Choice

Generations (HMO

SNP)

HMO Counties: APA,CCN, GIL, MAR,

MOH, NAV, PIM, PIN


H5590 BRIDGEWAY HEALTH SOLUTIONS Local CCP 003 0 Allwell Dual Medicare

(HMO SNP)

HMO Maricopa AZ 555 Dual-Eligible

H5594 OPTIMUM HEALTHCARE, INC. Local CCP 016 0 Optimum Emerald

Partial (HMO SNP)


H5594 OPTIMUM HEALTHCARE, INC. Local CCP 017 0 Optimum Emerald Full

(HMO SNP)


H5608 DENVER HEALTH MEDICAL PLAN,

INC.

Local CCP 001 0 Denver Health

Medicare Choice

(HMO SNP)

HMO Denver County CO 1,601 Dual-Eligible

H5619 ARCADIAN HEALTH PLAN, INC. Local CCP 003 0 Humana Gold Plus

SNP-DE H5619-003

(HMO SNP)

HMO Select Counties in Maine ME 1,784 Dual-Eligible


SNP-DE H5619-038

(HMO SNP)

HMO Select Counties in California CA 4,436 Dual-Eligible


SNP-DE H5619-054

(HMO SNP)

HMO Select counties in Indiana IN 4,611 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



SNP-DE H5619-067

(HMO SNP)

HMO King, Pierce and Snohomish

Counties

WA 1,067 Dual-Eligible


SNP-DE H5619-075

(HMO SNP)

HMO Central Kentucky Area KY 952 Dual-Eligible


SNP-DE H5619-076

(HMO SNP)

HMO Clark and Floyd counties IN 167 Dual-Eligible


SNP-DE H5619-082

(HMO SNP)

HMO Greater South Carolina SC 3,192 Dual-Eligible


SNP-DE H5619-093

(HMO SNP)

HMO Greater Alabama AL 3,939 Dual-Eligible

H5628 MOLINA HEALTHCARE OF UTAH, INC. Local CCP 001 0 Molina Medicare

Options Plus (HMO

SNP)

HMO Salt Lake City UT 6,524 Dual-Eligible

H5628 MOLINA HEALTHCARE OF UTAH, INC. Local CCP 006 0 Healthy Advantage

(HMO SNP)

HMO Salt Lake City UT 1,561 Dual-Eligible

H5628 MOLINA HEALTHCARE OF UTAH, INC. Local CCP 008 0 Molina Medicare

Options Plus (HMO

SNP)

HMO Idaho ID 371 Dual-Eligible FIDE SNP


CALIFORNIA, INC.

Local CCP 002 0 Central Health Medi-

Medi Plan (HMO SNP)

HMO Counties: LA and SB CA 4,533 Dual-Eligible


CALIFORNIA, INC.

Local CCP 009 0 Central Health Ventura

Medi-Medi Plan (HMO

SNP)

HMO Ventura County CA 481 Dual-Eligible

H5703 SOUTH COUNTRY HEALTH ALLIANCE Local CCP 001 0 AbilityCare (HMO

SNP)

HMO Select Counties in Minnesota MN 596 Dual-Eligible FIDE SNP

H5774 TRIPLE S ADVANTAGE, INC. Local CCP 024 0 Platino Plus (HMO

SNP)


H5774 TRIPLE S ADVANTAGE, INC. Local CCP 025 0 Platino Ultra (HMO

SNP)


H5774 TRIPLE S ADVANTAGE, INC. Local CCP 026 0 Platino Advance (HMO

SNP)



CALIFORNIA


Options Plus (HMO

SNP)

HMO Southern California CA 1,894 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H5817 AMERIGROUP TEXAS, INC. Local CCP 024 7 Amerivantage Dual

Coordination (HMO

SNP)



Coordination (HMO

SNP)



Coordination (HMO

SNP)



Coordination (HMO

SNP)



Coordination (HMO

SNP)



Coordination (HMO

SNP)



Premier (HMO SNP)

HMO Houston Area TX 4,867 Dual-Eligible


WASHINGTON, INC.


Options Plus (HMO

SNP)

HMO Seattle, Tacoma, Spokane WA 9,060 Dual-Eligible


WASHINGTON, INC.


Choice (HMO SNP)

HMO Pierce, Snohomish WA 634 Dual-Eligible

H5826 COMMUNITY HEALTH PLAN OF

WASHINGTON

Local CCP 014 0 Community HealthFirst

MA Special Needs

Plan (HMO SNP)

HMO Eastern and Western Washington

State

WA 3,626 Dual-Eligible

H5854 ANTHEM HEALTH PLANS, INC. Local CCP 008 0 Anthem MediBlue Dual

Advantage (HMO

SNP)

HMO Select Counties in Connecticut CT 21,360 Dual-Eligible

H5859 HEALTH PLAN OF CAREOREGON,

INC.

Local CCP 001 0 CareOregon

Advantage Plus (HMO-

POS SNP)

HMOPOS Portland Metro Area, Southern

Oregon, Northwest

OR 11,032 Dual-Eligible

H5926 MOLINA HEALTHCARE OF MICHIGAN,

INC.


Options Plus (HMO

SNP)

HMO Grand Rapids, Flint, Saginaw,

Detroit


H5928 CARE1ST HEALTH PLAN Local CCP 001 0 Care1st TotalDual

Plan (HMO SNP)

HMO Los Angeles County CA 471 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



Plan (HMO SNP)

HMO Orange and San Bernardino

Counties

CA 230 Dual-Eligible


Plan (HMO SNP)

HMO San Diego County CA 271 Dual-Eligible

H5932 GATEWAY HEALTH PLAN, INC. Local CCP 001 0 Gateway Health

Medicare Assured

Diamond (HMO SNP)

HMO Pennsylvania Counties PA 42,759 Dual-Eligible

H5932 GATEWAY HEALTH PLAN, INC. Local CCP 009 0 Gateway Health

Medicare Assured

Ruby (HMO SNP)

HMO Pennsylvania Counties PA 6,154 Dual-Eligible

H5937 UCARE MINNESOTA Local CCP 001 0 UCare Connect +

Medicare (HMO SNP)

HMO Twin Cities Metro Area,

Rochester, St. Cloud

MN 1,908 Dual-Eligible

H5969 ALOHACARE Local CCP 002 0 AlohaCare Advantage

Plus (HMO SNP)

HMO State of Hawaii HI 1,543 Dual-Eligible

H5991 AFFINITY HEALTH PLAN, INC. Local CCP 001 0 Affinity Medicare

Ultimate (HMO SNP)

HMO NYC, Nassau ,Orange, Rockland,

Suffolk,Westchester


H5991 AFFINITY HEALTH PLAN, INC. Local CCP 002 0 Affinity Medicare

Solutions (HMO SNP)

HMO NYC, Nassau ,Orange, Rockland,

Suffolk,Westchester


H5992 SENIOR WHOLE HEALTH OF NEW

YORK, INC.

Local CCP 007 0 Senior Whole Health of

New York NHC (HMO

SNP)

HMO Counties: Ki, Qu, Brx, NY, Wes,

and Na

NY 102 Dual-Eligible FIDE SNP


Plan (Willamette)

(HMO SNP)

HMO Marion and Polk Counties OR 3,251 Dual-Eligible


INSURANCE CORP


SNP-DE H6622-008

(HMO SNP)

HMO Select Counties in Montana MT 469 Dual-Eligible


INSURANCE CORP


SNP-DE H6622-015

(HMO SNP)

HMO Canton-Cincinnati-Columbus

Areas

OH 2,235 Dual-Eligible


INSURANCE CORP


SNP-DE H6622-018

(HMO SNP)

HMO Northern Kentucky Area KY 392 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



INSURANCE CORP

Local CCP 024 0 Humana Cleveland

Clinic Preferred SNP-

DE (HMO SNP)

HMO Cuyahoga County OH 146 Dual-Eligible


INSURANCE CORP


SNP-DE H6622-027

(HMO SNP)

HMO Western North Carolina Area NC 273 Dual-Eligible


INSURANCE CORP


SNP-DE H6622-038

(HMO SNP)

HMO Select counties in Pennsylvania PA 1,686 Dual-Eligible


INSURANCE CORP


SNP-DE H6622-048

(HMO SNP)

HMO Hattiesburg MS 316 Dual-Eligible

H6672 EON HEALTH, INC. (GA) Local CCP 001 0 EON DELUXE (HMO

SNP)

HMO Select Georgia Counties GA 131 Dual-Eligible

H6776 ELDERSERVE HEALTH, INC. Local CCP 002 0 RiverSpring MAP

(HMO SNP)

HMO Counties: Brx, Ki, Na, NY, Qu, Ri,

Wes

NY Dual-Eligible

H6864 GUILDNET, INC. Local CCP 001 0 GuildNet Gold (HMO

SNP)

HMO Bronx, Kings, NY, Queens,

Richmond

NY 430 Dual-Eligible FIDE SNP

H6988 CENTERS PLAN FOR HEALTHY

LIVING, LLC

Local CCP 002 0 Centers Plan for Dual

Coverage Care (HMO

SNP)

HMO Kings,Queens,Bronx,Manhattan

and Richmond Counties



LIVING, LLC

Local CCP 004 0 Centers Plan for

Medicaid Advantage

Plus (HMO SNP)

HMO NYC Metro Area, NASS, ROCK

County

NY Dual-Eligible

H7173 PEACH STATE HEALTH PLAN, INC. Local CCP 001 0 Allwell Dual Medicare

(HMO SNP)

HMO Metro Atlanta, North and Central

Regions

GA 505 Dual-Eligible

H7200 AMERIGROUP TENNESSEE, INC. Local CCP 006 0 Amerivantage Dual

Coordination (HMO

SNP)

HMO Select Counties in Tennessee TN 9,449 Dual-Eligible

H7464 UNITEDHEALTHCARE OF THE MID-

ATLANTIC, INC.


Complete (HMO SNP)

HMO Select Counties in VA VA 1,038 Dual-Eligible

H7678 MOLINA HEALTHCARE OF TEXAS,

INC.


Options Plus (HMO

SNP)

HMO Texas TX 1,590 Dual-Eligible

H8130 MOLINA HEALTHCARE OF FLORIDA,

INC.


Options Plus (HMO

SNP)

HMO Tampa, West Palm Beach, Miami FL 2,665 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H8133 GHS INSURANCE COMPANY Local CCP 009 0 Blue Cross Medicare

Advantage Dual Care

(HMO SNP)

HMO Bastrp,Burnet,Caldwl,Hays,Lee,&

Wilmson ctys

TX Dual-Eligible

H8189 MANAGED HEALTH SERVICES,

WISCONSIN


(HMO SNP)

HMO Southeastern, Northeastern,

Central Counties

WI 1,018 Dual-Eligible

H8298 HORIZON HEALTHCARE OF NEW

JERSEY, INC.

Local CCP 001 0 Horizon NJ TotalCare

(HMO SNP)

HMO 15 Counties Throughout New

Jersey

NJ 6,364 Dual-Eligible FIDE SNP

H8432 EMPIRE HEALTHCHOICE HMO, INC. Local CCP 002 0 Anthem MediBlue Dual

Advantage (HMO

SNP)

HMO Select Counties in Maine ME 3,306 Dual-Eligible

H8432 EMPIRE HEALTHCHOICE HMO, INC. Local CCP 007 0 Empire MediBlue Dual

Advantage (HMO

SNP)

HMO New York City Area NY 10,757 Dual-Eligible

H8432 EMPIRE HEALTHCHOICE HMO, INC. Local CCP 018 0 Empire MediBlue Dual

Advantage (HMO

SNP)

HMO Albany, Rensselaer, Schenectady,

Dutchess, Putnam


H8854 UNIVERSITY OF MARYLAND HEALTH

ADVANTAGE, INC.

Local CCP 002 0 University of Maryland

Health Advantage Dual

(HMO SNP)

HMO Central Maryland and Select

Eastern Shore counties

MD 3,490 Dual-Eligible

H9001 FALLON COMMUNITY HEALTH PLAN Local CCP 019 0 NaviCare (HMO SNP) HMO Massachusetts except Dukes and

Nantucket counties


H9047 PROVIDENCE HEALTH ASSURANCE Local CCP 043 0 Providence Medicare

Dual Plus (HMO SNP)

HMO Portland Metro OR 671 Dual-Eligible

H9082 MOLINA HEALTHCARE OF NEW

MEXICO, INC.


Options Plus (HMO

SNP)

HMO Albuquerque, Santa Fe NM 4,599 Dual-Eligible

H9190 GATEWAY HEALTH PLAN OF OHIO,

INC.

Local CCP 001 0 Gateway Health

Medicare Assured

Diamond (HMO SNP)

HMO Ohio Counties OH 1,406 Dual-Eligible


INC.


Medicare Assured

Ruby (HMO SNP)

HMO Ohio Counties OH 335 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



INC.


Medicare Assured

Diamond (HMO SNP)

HMO North Carolina Counties NC 1,432 Dual-Eligible


INC.


Medicare Assured

Ruby (HMO SNP)

HMO North Carolina Counties NC 254 Dual-Eligible


INC.


Medicare Assured

Diamond (HMO SNP)

HMO Kentucky Counties KY 704 Dual-Eligible


INC.


Medicare Assured

Ruby (HMO SNP)

HMO Kentucky Counties KY 140 Dual-Eligible

H9207 HEALTH PARTNERS PLANS, INC. Local CCP 004 0 Health Partners

Medicare Special

(HMO SNP)

HMO Bucks, Chester, Del, Lan, Leh,

Montg, Nrtha, Phil

PA 12,431 Dual-Eligible

H9403 EON HEALTH, INC. (SC) Local CCP 001 0 EON DELUXE (HMO

SNP)

HMO Select South Carolina Counties SC 91 Dual-Eligible

H9525 COMPCARE HEALTH SERVICES

INSURANCE CORPORATION

Local CCP 003 0 Anthem MediBlue Dual

Advantage (HMO

SNP)

HMO Select Counties in Wisconsin WI 764 Dual-Eligible

H9525 COMPCARE HEALTH SERVICES

INSURANCE CORPORATION


Advantage (HMO

SNP)

HMO Select counties in KY KY 2,240 Dual-Eligible

H9585 BOSTON MEDICAL CENTER HEALTH

PLAN, INC.

Local CCP 001 0 BMC HealthNet Plan

Senior Care Options

(HMO SNP)

HMO Barnstable, Bristol, Hampden,

Plymouth, Suffolk

MA 442 Dual-Eligible FIDE SNP

H9725 CIGNA HEALTHCARE OF NORTH

CAROLINA, INC.


TotalCare (HMO SNP)

HMO Select North Carolina Counties NC 654 Dual-Eligible

H9730 WELLCARE HEALTH INSURANCE

COMPANY OF KENTUCKY, INC

Local CCP 003 0 Wellcare Access (HMO

SNP)

HMO Select Counties in KY KY 4,072 Dual-Eligible

H9730 WELLCARE HEALTH INSURANCE

COMPANY OF KENTUCKY, INC


SNP)

HMO Select KY Counties KY 1,575 Dual-Eligible

H9870 UNIVERSITY HEALTH CARE, INC. Local CCP 001 0 Passport Advantage

(HMO SNP)

HMO Jefferson, Hardin, Bullitt and

Nelson Counties

KY 2,260 Dual-Eligible

H9877 VIRGINIA PREMIER HEALTH PLAN,

INC.

Local CCP 001 0 Virginia Premier

Advantage Elite (HMO

SNP)

HMO Central, Tidewater, Western,

Roanoke, NOVA

VA 2,274 Dual-Eligible

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H9886 HMO MISSOURI, INC. Local CCP 003 0 Anthem MediBlue Dual

Advantage (HMO

SNP)

HMO Select Counties in Missouri MO 2,119 Dual-Eligible


Choice Dual

Advantage (HMO

SNP)

HMO DC Metro DC 123 Dual-Eligible


Choice Dual

Advantage (HMO

SNP)

HMO Baltimore Metro, Baltimore and

DC Suburb

MD 911 Dual-Eligible

H9954 ANTHEM INSURANCE COMPANIES,

INC.


Advantage (HMO

SNP)

HMO Select Counties in Indiana IN 5,975 Dual-Eligible


CO OF THE RIVER VALLEY

Regional CCP 001 0 UnitedHealthcare Dual

Complete RP

(Regional PPO SNP)

Regional PPO North Carolina and Virginia NC; VA 16,363 Dual-Eligible


COMPANY


Complete RP

(Regional PPO SNP)

Regional PPO State of Hawaii HI 4,156 Dual-Eligible




Plus Dual Advantage

(Regional PPO SNP)

Regional PPO Arkansas and Missouri AR; MO 25,935 Dual-Eligible




Plus Dual Advantage

(Regional PPO SNP)

Regional PPO Texas TX 20,197 Dual-Eligible


COMPANY


Plus Dual Advantage

(Regional PPO SNP)

Regional PPO Georgia and South Carolina GA; SC 50,607 Dual-Eligible FIDE SNP


COMPANY


Complete RP

(Regional PPO SNP)

Regional PPO State of Florida FL 51,572 Dual-Eligible FIDE SNP

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



COMPANY


Complete RP ONE

(Regional PPO SNP)

Regional PPO State of Florida FL 605 Dual-Eligible

Under-11 14 Dual-Eligible

H0544 BLUE CROSS OF CALIFORNIA Local CCP 005 0 Anthem Touch (HMO

SNP)

HMO Los Angeles and Orange Counties CA 2,328 Institutional

H0544 BLUE CROSS OF CALIFORNIA Local CCP 050 0 Anthem Touch (HMO

SNP)

HMO Santa Clara County CA 273 Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO State of Connecticut CT 3,573 Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Select Counties in Alabama and

Florida

AL; FL 808 Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Maricopa, Pima, and Yavapai

counties

AZ 1,040 Institutional


COMPANY


Assisted Living Plan

(PPO SNP)

Local PPO Maricopa, Pima, and Yavapai

counties

AZ Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Denver and Colorado Springs

metro areas

CO 3,102 Institutional


COMPANY



(PPO SNP)

Local PPO Denver and Colorado Springs

metro areas

CO 103 Institutional


COMPANY



(PPO SNP)

Local PPO State of Connecticut CT Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Select Counties in Florida FL 4,108 Institutional


COMPANY



(PPO SNP)

Local PPO Select Counties in Florida FL Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Select Counties in Indiana IN 1,466 Institutional

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Select Counties in Maine and New

Hampshire

ME; NH 351 Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO St. Louis Metro area IL; MO 401 Institutional


COMPANY


Nursing Home Plan 2

(PPO SNP)

Local PPO Select Counties in Pennsylvania

and Delaware

DE; PA 4,585 Institutional


COMPANY



(PPO SNP)

Local PPO Select Counties in Pennsylvania PA Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Select counties in Texas TX 410 Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Select counties in New Jersey NJ 2,278 Institutional


COMPANY


Nursing Home Plan 2

(PPO SNP)

Local PPO Select Counties in Ohio OH 130 Institutional


COMPANY



(PPO SNP)

Local PPO Select counties in Washington WA Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Select counties in Washington WA 1,723 Institutional


COMPANY


Nursing Home Plan 2

(PPO SNP)

Local PPO Select Counties in Maryland,

Virginia and DC

DC; MD; VA 210 Institutional


COMPANY


Nursing Home Plan 2

(PPO SNP)

Local PPO Select Counties in Georgia GA 96 Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Select Counties in North Carolina NC 48 Institutional


COMPANY


Nursing Home Plan 2

(PPO SNP)

Local PPO State of Rhode Island RI 25 Institutional

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



COMPANY


Nursing Home Plan 2

(PPO SNP)

Local PPO Select Counties in Oregon OR Institutional


COMPANY


Assisted Living Plan 2

(PPO SNP)

Local PPO Select Counties in Oregon OR Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Hillsborough County FL 333 Institutional

H1372 MARQUIS ADVANTAGE, INC. Local CCP 001 0 AgeRight Advantage

Health Plan (HMO

SNP)

HMO OR Counties: CLK, KLA, MUL,

WSH & YAM

OR 417 Institutional

H1587 ARKANSAS SUPERIOR SELECT, INC. Local CCP 003 0 Select (HMO-POS

SNP)

HMOPOS Arkansas AR Institutional

H1777 CATHOLIC SPECIAL NEEDS PLAN,

LLC

Local CCP 007 0 ArchCare Advantage

(HMO SNP)

HMO NYC, Westchester, Putnam,

Dutchess, Orange, Ononda

NY 1,718 Institutional

H1787 GOOD SAMARITAN INSURANCE PLAN

OF SOUTH DAKOTA, INC

Local CCP 001 0 Great Plains Medicare

Advantage (HMO

SNP)

HMO South Dakota (partial) SD 217 Institutional


Traditions (HMO SNP)

HMO Maryland, Washington DC, and

Delaware Counties

DC; DE; MD 235 Institutional

H2185 LIFEWORKS ADVANTAGE, LLC Local CCP 001 0 LifeWorks Advantage I-

SNP (HMO SNP)

HMO Western and Central Virginia VA 744 Institutional


COMPANY


Nursing Home Plan

(PPO SNP)

Local PPO Boston, Springfield and Worcester

Metro Areas

MA 94 Institutional


COMPANY


Nursing Home Plan 1

(PPO SNP)

Local PPO State of Rhode Island RI 1,693 Institutional


COMPANY


Nursing Home Plan 1

(PPO SNP)

Local PPO Select Counties in Delaware,

Maryland and Virginia

DC; DE;

MD; VA

3,080 Institutional


COMPANY



(PPO SNP)

Local PPO Select Counties in Maryland and

DC

DC; MD Institutional

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



COMPANY



(PPO SNP)

Local PPO Kent and New Castle counties DE Institutional


COMPANY


Nursing Home Plan 1

(PPO SNP)

Local PPO Select Counties in Georgia GA 2,663 Institutional


COMPANY


Nursing Home Plan 1

(PPO SNP)

Local PPO Select Counties in Oregon OR 447 Institutional


COMPANY


Assisted Living Plan 1

(PPO SNP)

Local PPO Select Counties in Oregon OR 292 Institutional


COMPANY



(PPO SNP)

Local PPO State of Rhode Island RI Institutional

H2392 KANSAS SUPERIOR SELECT, INC. Local CCP 001 0 Kansas Superior

Select Skilled Care

Plan (HMO SNP)

HMO Eastern Kansas KS 72 Institutional

H2400 SIGNATURE ADVANTAGE, LLC Local CCP 001 0 Signature Advantage

(HMO SNP)

HMO KY (partial) KY 174 Institutional




Nursing Home Plan 1

(PPO SNP)

Local PPO Select Counties in Ohio OH 1,652 Institutional


ARIZONA, INC.

Local CCP 003 0 CareMore Care To

You (HMO SNP)

HMO Pima County AZ 1,035 Institutional


ARIZONA, INC.

Local CCP 019 0 CareMore Care To

You (HMO SNP)

HMO Maricopa County (partial) AZ 609 Institutional


MIDLANDS, INC.


Nursing Home Plan

(HMO-POS SNP)

HMOPOS Chicago Metro area IL 746 Institutional

H3113 OXFORD HEALTH PLANS (NJ), INC. Local CCP 001 0 UnitedHealthcare

Nursing Home Plan

(HMO SNP)

HMO Northern and Central New Jersey NJ 235 Institutional

H3113 OXFORD HEALTH PLANS (NJ), INC. Local CCP 008 0 UnitedHealthcare


(HMO SNP)

HMO Lane County OR 158 Institutional

H3291 PRUITTHEALTH PREMIER, INC. Local CCP 001 0 PruittHealth Premier

(HMO SNP)

HMO Georgia (partial) GA 1,759 Institutional

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H3347 ELDERPLAN, INC. Local CCP 003 0 Elderplan Advantage

For Nursing Home

Residents (HMO SNP)

HMO Brx, Ki, Monr, Na, NY, Qu, Ri, Suf,

Wes

NY 1,598 Institutional

H3359 HEALTHFIRST HEALTH PLAN, INC. Local CCP 035 0 Healthfirst

AssuredCare (HMO

SNP)

HMO New York City and Nassau County NY 428 Institutional

H3362 INDEPENDENT HEALTH

ASSOCIATION, INC.

Local CCP 020 0 Independent Health

Medicare Family

Choice (HMO SNP)

HMO Western New York NY 1,279 Institutional


INC.


Nursing Home Plan

(HMO SNP)

HMO New York City metro area NY 7,860 Institutional


INC.


Nursing Home Plan

(HMO SNP)

HMO Upstate New York NY 4,264 Institutional


INC.


Nursing Home Plan

(HMO SNP)

HMO Jefferson County NY 175 Institutional


Touch (HMO SNP)



VA 183 Institutional

H3708 OKLAHOMA SUPERIOR SELECT, INC. Local CCP 001 0 Tribute Health Plan of

Oklahoma (HMO SNP)

HMO Greater Ardmore Metro Area OK 216 Institutional




Nursing Home Plan

(HMO SNP)

HMO Kenosha and Rock counties WI Institutional

H3907 UPMC HEALTH PLAN, INC. Local CCP 032 0 UPMC for Life Options

(HMO SNP)

HMO Allegheny, Erie, Washington PA

Counties

PA 108 Institutional

H3930 SPARTAN PLAN NY, INC. Local CCP 001 0 Sunrise Advantage

Plan I-SNP (HMO

SNP)

HMO New York (partial) NY 23 Institutional


Traditions (HMO SNP)

HMO Select Pennsylvania Counties PA 138 Institutional

H4091 SIMPRA ADVANTAGE, INC. Local CCP 001 0 Simpra Advantage

(PPO SNP)

Local PPO Alabama statewide AL 1,792 Institutional

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H4093 PROVIDER PARTNERS HEALTH PLAN

OF PENNSYLVANIA, INC

Local CCP 001 0 Provider Partners

Pennsylvania

Advantage Plan (HMO

SNP)

HMO PA East & West Borders PA 571 Institutional

H4172 NHC ADVANTAGE, LLC Local CCP 001 0 NHC Advantage (HMO

SNP)

HMO MO Counties: CAM, GRE, JAK,

JAS, SCH & STL

MO 130 Institutional

H4236 SPARTAN PLAN PA, INC. Local CCP 001 0 Sunrise Advantage

Plan I-SNP (HMO

SNP)

HMO Pennsylvania (partial) PA 44 Institutional

H4346 HMO COLORADO, INC. Local CCP 010 0 Anthem Touch (HMO

SNP)

HMO Clark County NV 667 Institutional

H4490 MISSOURI MEDICARE SELECT, LLC Local CCP 001 0 Missouri Medicare

Select (HMO SNP)

HMO MO Counties: CAS, JAK, LAF,

SCH & STL

MO 155 Institutional

H4778 SPARTAN PLAN IL, INC. Local CCP 001 0 Sunrise Advantage

Plan I-SNP (HMO

SNP)

HMO Illinois (partial) IL 39 Institutional


CareWell (HMO SNP)


Island, Westchester

NY 365 Institutional


COMPANY


Nursing Home Plan

(HMO SNP)

HMO Select Counties in Washington WA 209 Institutional


WISCONSIN, INC.


Nursing Home Plan

(HMO-POS SNP)

HMOPOS Select Counties in Wisconsin WI 1,915 Institutional


WISCONSIN, INC.


Nursing Home Plan

(HMO SNP)

HMO Select Counties in North Carolina NC 3,131 Institutional


WISCONSIN, INC.



(HMO-POS SNP)

HMOPOS Select Counties in North Carolina NC Institutional


WISCONSIN, INC.


Nursing Home Plan

(HMO-POS SNP)

HMOPOS Select Counties in Ohio OH 351 Institutional


WISCONSIN, INC.



(HMO-POS SNP)

HMOPOS Select Counties in Ohio OH Institutional

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan



WISCONSIN, INC.



(HMO-POS SNP)

HMOPOS Select Counties in Wisconsin WI 287 Institutional




Nursing Home Plan

(HMO-POS SNP)

HMOPOS Select Counties in AL, OH, SC

and VA

AL; OH; SC;

VA

178 Institutional




Nursing Home Plan

(HMO SNP)

HMO Select Counties in FL, IN and NJ FL; IN; NJ 377 Institutional




Nursing Home Plan

(HMO-POS SNP)

HMOPOS Atlanta and Augusta Metro areas GA 234 Institutional

H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 008 0 Simply Care (HMO

SNP)

HMO Miami-Dade County FL 15 Institutional

H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 009 0 Simply Comfort (HMO

SNP)

HMO Miami-Dade County FL 221 Institutional

H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 053 0 Simply Care (HMO

SNP)

HMO Broward County FL Institutional

H5471 SIMPLY HEALTHCARE PLANS, INC. Local CCP 055 0 Simply Comfort (HMO

SNP)

HMO Broward County FL Institutional



Local CCP 003 0 Erickson Advantage

Guardian (HMO-POS

SNP)

HMOPOS Erickson Campuses -

CO,KS,MA,MD,MI,NJ,PA,TX,VA,N

C

CO; KS;

MA; MD; MI;

NC; NJ; PA;

TX; VA

183 Institutional

H5989 CENTERLIGHT HEALTHCARE, INC. Local CCP 002 0 CenterLight Healthcare

Direct Complete Plan

(HMO SNP)

HMO NYC, LI, Westchester and

Rockland Counties


H6351 LIBERTY ADVANTAGE, LLC Local CCP 001 0 Liberty Advantage

(HMO SNP)

HMO North Carolina (partial) NC 618 Institutional

H6776 ELDERSERVE HEALTH, INC. Local CCP 001 0 RiverSpring Star (HMO

SNP)

HMO Counties: Brx, Ki, Na, NY, Qu, Ri,

Wes



LIVING, LLC

Local CCP 003 0 Centers Plan for

Nursing Home Care

(HMO SNP)

HMO NYC Metro Area, Rockland, Erie,

Niagara Counties

NY 32 Institutional


OF NEBRASKA, INC.


Advantage (HMO

SNP)

HMO Nebraska (partial) NE 414 Institutional

SNP_2018_05.xls

Contract


Organization

Type Plan ID

Segment


Plan

Enrollment

Special

Needs Plan


H7802 SPARTAN PLAN VA, INC. Local CCP 001 0 Sunrise Advantage

Plan I-SNP (HMO

SNP)

HMO Virginia (partial) VA 29 Institutional

H8067 PROVIDER PARTNERS HEALTH

PLAN, INC.

Local CCP 001 0 Provider Partners

Maryland Advantage

Plan (HMO SNP)

HMO Western & Central Maryland MD 288 Institutional


OF NORTH DAKOTA, LLC


Advantage (HMO

SNP)

HMO North Dakota (partial) ND 156 Institutional

H9104 SCAN HEALTH PLAN Local CCP 006 0 SCAN Healthy at

Home (HMO SNP)

HMO Los Angeles, Orange, and Inland

Empire Areas

CA 54 Institutional

H9153 WEST VIRGINIA SENIOR

ADVANTAGE, INC.

Local CCP 001 0 WV Senior Advantage

(HMO SNP)

HMO BER,GRB,HSN,KA,MNL,MGL,MR

O,MOR,PL,PR,RAL&WOD

WV 507 Institutional

Under-11 8 Institutional

SNP_2018_05.xls

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