Office of Personnel Management

Retirement and Insurance Service

1920 1954 1959 1986 

 

Benefits Administration Letter

Number: 96-404 Date: September 30, 1996 

SUBJECT: FEHB Open Season: Significant Plan Changes

_____________________________________________________________________

GENERAL

________________________________________________

 Purpose This Letter transmits lists of significant events affecting

certain health plans during the upcoming FEHB open

season. Some of these events will require action on the

part of agencies.

_____________________________________________________________________

TERMINATIONS

________________________________________________

 Attachment 1 These plans are dropping out of the FEHB Program at the

end of 1996.

________________________________________________

 What Must Employees in these plans must choose a new health plan

 Employees Do? during open season.

Employees who do not choose a new health plan will be

considered to have cancelled their coverage and will not

have health benefits for 1997.

________________________________________________

 New Coverage Coverage under an enrollee's "new" health plan will be

effective the first day of the first pay period beginning on or

after January 1; for most employees, this will be January 5. 

Enrollees will remain covered and receive benefits under

the "old" plan or code until the new coverage becomes

effective.

________________________________________________
Benefits Administration Letter 96-404

-2-

 Plan Each plan on the list is supposed to notify its enrollees of

 Notification the plan's withdrawal and the need to select a new health

plan for 1997. However, some plans' enrollment records

and address lists may not be up to date.

________________________________________________

 Attachment 2 These plans are terminating an enrollment area that has a

separate enrollment code.

Employees in the terminating enrollment area must choose

a new plan during open season, since their enrollment code

will no longer be valid.

The effect of such a termination and the actions required of

both agencies and employees are the same as if the entire

plan were terminating.

________________________________________________

 What Must Agencies must notify employees in these terminating

 Agencies Do? plans and enrollment areas of the need to select a new

health plan to avoid losing coverage. This is especially

important since many employees will not receive a copy of

the FEHB Guide and will therefore be unable to check the

comparison chart to see if their plan will still be participating

in 1997.

We strongly recommend that you notify employees by

distributing copies of these lists to each employee, along

with your agency's notice to employees about open season.

We also recommend that, before the end of open season,

you follow up with employees in these plans who have not

submitted an SF 2809 and remind them to select a new

health plan.

________________________________________________

 Belated Changes Despite these precautions, there will be some enrollees who

do not "get the word" to change health plans during open

season. We encourage you to be liberal in using your

authority to accept belated open season changes from

employees enrolled in a terminated health plan.
Benefits Administration Letter 96-404

-3-

_____________________________________________________________________

ENROLLMENT AREA REDUCTIONS

________________________________________________

 Attachment 3 These plans are significantly reducing an enrollment area,

but it does not involve terminating an enrollment code. 

Enrollees in the area being eliminated should choose a new

health plan for 1997.

Enrollees who do not choose a new health plan during open

season will have to travel to the plan's service area to obtain

medical care in order to receive full benefits from the plan.

________________________________________________

 Agency Action You may wish to distribute a copy of this list to each

 Required employee, along with your agency's notice to employees

about open season. If you don't distribute the lists, remind

employees to check their health plan brochure carefully to

see if there have been any changes to the plan's enrollment

area which would affect them and to change to a new health

plan if necessary.

_____________________________________________________________________

OTHER ENROLLMENT AREA CHANGES

________________________________________________

Attachment 4 This plan is splitting its current enrollment area into two 

separate areas with different enrollment codes. Enrollees 

should check the plan brochure to determine which code 

they should be under and, if necessary, complete an SF 

2809 to change to the correct enrollment code.

Enrollees who should change codes, but don't, will have 

to travel to the area served by their enrollment code to 

obtain medical care in order to receive full benefits. 

______________________________________________________
Benefits Administration Letter 96-404

-4-

Attachment 5 These plans are splitting their current enrollment area into

two separate areas with different enrollment codes. 

Enrollees should check their plan brochure to determine

which enrollment code they should be under and, if

necessary, complete an SF 2809 to change to the correct

enrollment code.

Enrollees who should change codes, but don't, will still have

free access to all plan providers. However, they will pay a

higher premium.

________________________________________________

Attachment 6 This plan is transferring a service area from one existing 

enrollment code to another existing enrollment code. 

Enrollees should check the plan brochure to determine 

which enrollment code they should be under and, if 

necessary, complete an SF 2809 to change to the correct 

enrollment code.

Enrollees who should change codes, but don't, will still 

have free access to all plan providers. However, they 

will pay a higher premium.

______________________________________________________ 

Attachment 7 These plans are consolidating enrollment areas, i.e.,

changing from two enrollment codes to one enrollment

code. The enrollment areas will remain the same; however,

they will be included under one enrollment code. Enrollees

in the "departing" enrollment code will be transferred

automatically to the remaining enrollment code.

_____________________________________________________________________

ADDITIONS AND EXPANSIONS

________________________________________________

 Attachment 8 These are new plans entering the FEHB Program in 1997. 

We have indicated the general area served by each plan.

________________________________________________

 Attachment 9 These plans are expanding their enrollment area, with the

new area having a separate enrollment code. We have

given a general description of the expanded areas.

________________________________________________
Benefits Administration Letter 96-404

-5-

 Attachment 10 These plans are significantly expanding their enrollment

area without adding a new enrollment code. We have

included a general description of the expanded areas.

________________________________________________

 Agency Action Be sure to include these new plans and expanded

 Required enrollment areas when you count the number of eligible

employees and place your orders for brochures.

_____________________________________________________________________

MISCELLANEOUS CHANGES

________________________________________________

 Attachment 11 These plans are merging with another plan at the end of

1996. Enrollees in the "old" plan(s) will be transferred

automatically to the "new" plan and need take no action. 

Any enrollees in the "old" plan(s) who do not wish to be

transferred to the "new" plan must choose a different health

plan during open season.

________________________________________________

 Attachment 12 These plans have changed their names for 1997. 

________________________________________________

 Attachment 13 These plans have changed enrollment codes. Enrollees in

these plans will be transferred automatically to the new

enrollment code.

_____________________________________________________________________

Abby L. Block, Chief

Insurance Policy 

 and Information Division

Attachments
ATTACHMENT 1

PLANS DROPPING OUT OF FEHBP FOR 1997

Employees in these plans who do not change health plans during open season will

not have health benefits for 1997.

Plan Name Code General Location

NAPUS YC Government-wide

CIGNA HealthCare of TX 3C Dallas/Ft. Worth

Community Health Care Plan CT counties of Fairfield, Hartford, Litchfield,

HealthKeepers Washington, DC area

Healthsource North Carolina Most of North Carolina

Healthsource/Managed Care Most of Indiana

Plan

HealthWise of Tennessee Nashville area/Shelby County

HMO Kansas Capitol & Witchita areas/Central KS

Lifeguard Health Plan Northern California

Managed Health Services Southeastern Wisconsin

MetraHealth Care Plan/IL Kane, Lake, DuPage, Cook, McHenry, and

Principal Health Care of IL ZS Chicago area 

Principal Health Care of Mid- Most of Maryland

Atlantic

Humana Health-Ohio Southwestern Ohio

HMO Blue New Jersey/Bucks County, Pennsylvania

71

X9

RQ

XD

2W

HM

CD

VQ

WL

XB

DS

SQ

XZ

Middlesex, and New Haven

Will counties

East St. Louis/Southern IL
ATTACHMENT 1

PruCare of Tampa Bay FH Tampa Bay area

HMO Blue QD Massachusetts, Southern New Hampshire,

United HealthCare of Utah UT Northwestern Utah

PHP-South Carolina XV Costal/Midlands/PeeDee/Piedmont

Medica Choice DR Most of Minnesota and portions of Wisconsin

Humana HP of Alabama NS,

Bay State Health Care KW

Aetna HPs of W. PA XT

PacifiCare of Florida 3P Pinellas counties

HealthWise of Arkansas 1W

Intergroup of Utah 1I

PY

and Litchfield County, Connecticut

Birmingham/Huntsville/Montgomery

Eastern Massachusetts

Pittsburgh area

Broward, Dade, Palm Beach, Hillsboro, and

Central Arkansas

Wasatch Front
ATTACHMENT 2

PLANS REDUCING THEIR SERVICE/ENROLLMENT AREA

BY TERMINATING AN ENROLLMENT CODE

Employees in these enrollment codes who do not change health plans during open

season will not have health benefits for 1997.

Plan Name Code Area Dropped

BlueChoice HMO S1 New York counties of Columbia, Delaware,

(Formerly Empire BC/BS Essex, Greene, North Saratoga, Schoharie,

HEALTHNET) Warren, and Washington 

(This Plan also has Code S7

which is unaffected)

BlueChoice HMO S2 New York counties of Albany, Dutchess,

(Formerly Empire BC/BS Fulton, Montgomery, Orange, Putnam,

HEALTHNET) Rensselaer, Schenectady, South Saratoga,

(This Plan also has Code S7 Sullivan, and Ulster 

which is unaffected)

Oxford Health Plans GD All of New Jersey

Principal Health Care of Kansas NU Boone, Callaway, Cole, Cooper, Franklin,

City Jefferson, Miller, Moniteau, Montgomery,

Humana Medical Plan (Florida) VK Florida Panhandle

Humana Care Plan (Kentucky) TY Northern Kentucky

Humana Care Plan (Indiana) 4I Indianapolis area

UY Brevard County

Morgan, Osage, Randolph, St. Charles, St.

Francois, Warren, and St. Louis Counties, and

St. Louis City in Missouri
ATTACHMENT 3

PLANS SIGNIFICANTLY REDUCING THEIR SERVICE/ENROLLMENT AREA

WITHOUT TERMINATING AN ENROLLMENT CODE

Enrollees in the areas being dropped who do not change health plans during open

season will have to travel to the plan's remaining service area to obtain medical

care in order to receive full benefits from the plan for 1997.

Plan Name Code Area Dropped

Atrium Health Plan (formerly CV Wisconsin Counties of Crawford, Grant,

HMO Midwest) Juneau, La Crosse, Monroe, Richland,

Blue Choice MK New York counties of Genesee, Orleans, and

HMO Virginia V7 Isle of Wight County and the cities of

PCA Texas TW Kerr County

Antero Health Plans- 9X Alamosa, Clear Creek, Elbert, El Paso,

formerly ExclusiCare (Colorado) (was Fremont, Gilpin, Larimer, Logan, Morgan,

United HealthCare of Florida 1X Calhoun, Franklin, Gulf, and Liberty counties

ZD) Pueblo, Teller, Weld, and Yuma counties

Trempeleau and Vernon

Wyoming 

Chesapeake, Norfolk, Virginia Beach, Suffolk,

and Portsmouth
ATTACHMENT 4

PLANS SPLITTING A SERVICE/ENROLLMENT AREA

Enrollees in these plans under the 1996 enrollment codes shown below should

check their plan brochure to determine which 1997 code they should be under. 

Employees in these 1996 enrollment codes who should change codes, but do not,

will have to travel to the area served by their enrollment code to obtain medical

care in order to receive full benefits from the plan.

Plan Name 1996 Code 1997 Codes

Foundation Health- C6 C6, 6R

California
ATTACHMENT 5

PLANS SPLITTING A SERVICE/ENROLLMENT AREA

Enrollees in these plans under the 1996 enrollment codes shown below should

check their plan brochure to determine which 1997 code they should be under. 

Employees in these 1996 enrollment codes who should change codes, but do not,

will still have free access among all plan providers but will pay a higher premium

for their coverage.

Plan Name 1996 Code 1997 Codes

HMO-CNY (NY, PA) CE CE, 4E

Principal Health Care N3 N3, 7W

of Kansas City

Principal Health Care of Florida C2 C2, 2Z
ATTACHMENT 6

PARTIAL SERVICE AREA TRANSFERS

FROM ONE EXISTING ENROLLMENT CODE

TO ANOTHER EXISTING ENROLLMENT CODE

Enrollees in these areas who do not change codes during open season will still

have free access among all plan providers but will pay a higher premium for their

coverage.

Plan Name Code Part Being Transferred New Code

HealthAmerica 1N Blair and Huntington counties ZN

Pennsylvania
ATTACHMENT 7

SERVICE/ENROLLMENT AREA CONSOLIDATIONS,

TRANSFERRING TWO ENROLLMENT CODES INTO ONE

Enrollees in the former enrollment code being dropped will be transferred

automatically to the remaining enrollment code unless they choose a different

health plan during open season.

Plan Name Former Codes Remaining Code

Aetna HPs of Ohio Z4,4D,RD RD

Care Choices KZ, FE KZ

FHP, Inc. 66, VP, CY CY

Prudential HealthCare 1Z, EZ EZ

HMO-Atlanta

Prudential HealthCare HD, JB JB

HMO-Mid-Atlantic

WellCare of New York 3V, X4 X4
ATTACHMENT 8

NEW PLANS ENTERING THE PROGRAM FOR 1997

State Plan Name

NC Doctors Health Plan Code

SC Doctors Health Plan 6D

AZ HMO AZ BlueSelect 6D

CO Frontier Community 5T, 5V

OK Healthcare OK 6F

PA Alliance Health Network 6W

TX Healthsource North Texas 5A

GA Healthsource Georgia 6H

KY Healthsource Kentucky

NC Personal Care Plan of NC, 8H

NC U.S. Healthcare of the

SC U.S. Healthcare of the

VA QualChoice of Virginia

TX HMO Blue

TX HMO Blue

OR HMO Oregon 4Z

OR Health Maintenance of 7A

All of Arizona

Inc. Charlotte, Durham,

Carolinas Charlotte/Metrolina area 

Carolinas Costal/Midlands/Piedmont

Oregon, Inc. Portland area

7H /Rome/Columbus

4X Greensboro, Raleigh 

3G 

3G

2Q Valley/Roanoke/N.VA

4Y Antonio, and South Texas

6B

General Location

Charlotte area

York County

The Front Range

OK City/Tulsa areas

Erie area 

Greater Fort Worth Area

Atlanta/Macon/Augusta

Louisville area 

Charlottesville/Shen

Austin, Beaumont, Houston, San

Dallas/Fort Worth

Most of Oregon
ATTACHMENT 8

WA Health Maintenance of 6B Clark, Klickitat, and Skamania

PA HIP Health Plan of 5J Bucks, Delaware, Montgomery,

ND Northern Plains Health Plan 2R Northeast ND

MN Northern Plains Health Plan 2R Northwest MN

FL Healthplan Southeast 3E Pensacola, Tallahassee, 

MD, CapitalCare 2G Gainesville, Panama

DC, City

VA 

KS Premier Blue 5N

AR Health Advantage 3D

MT Yellowstone Community 2Y

CO Foundation Health 2D Billings area

WA NYLCare HPs Northwest 8N Denver/Boulder/Colorado

NC WellPath Select 2E

AZ Premier Healthcare of 9A, 9B

WV PrimeONE 9W Most of Arizona

LA Smart Plan 9S

TX HMO Blue-West Texas 5Q

TX HMO Blue-SW Texas 5R

Oregon, Inc. counties

Pennsylvania and Philadelphia counties

Health Plan All of Arkansas

Arizona Charlotte/Triangle area

Washington, DC area

Topeka/Wichita/Central KS

Springs/Pueblo

Seattle area

All of West Virginia

Metairie

West Texas

Southwest Texas
ATTACHMENT 9

SERVICE/ENROLLMENT AREA EXPANSIONS

WITH A NEW ENROLLMENT CODE

State Plan Name New Code General Location

IA SecureCare of Iowa 3Q Iowa City area

NY WellCare of New York 6V Brooklyn,Bronx, Manhattan,

OH Health Power HMO 3R Cleveland, Youngstown 

PA HealthAmerica PA 4N Northeast, Central PA 

PA Oxford Health Plans 3W Philadelphia area

VA Heritage National Healthplan, 3X Cities of Radford, Roanoke, and

PA QualMed Plans for Health 2K Lackawanna and Luzerne

Inc. Salem; and the counties of

Queens

Botetourt, Craig, Floyd, Franklin,

Giles, Montgomery, Pulaski, and

Roanoke

counties
ATTACHMENT 10

SIGNIFICANT SERVICE/ENROLLMENT AREA EXPANSIONS

WITH NO NEW ENROLLMENT CODES

State Plan Name Code Added

IN Prudential HealthCare HMO- S3 Franklin, Ohio, Ripley,

KY Prudential HealthCare HMO- S3 Mason, Owen, and Scott

OH Prudential HealthCare HMO- S3 Clinton, Darke, Fayette, Greene,

ME Harvard Community Health 68 Leeds, Mechanic Falls, Minot,

NM Presbyterian Health Plan W8 Eddy, Otero, and Sierra counties

ME HMO Maine CU Monterey, Placer, Riverside, San

CA PacifiCare of CA CQ have added additional Zip codes.

Cincinnati Switzerland, and Union counties

Cincinnati counties

Cincinnati Highland, Miami, Montgomery,

Plan Monmouth, Norway, Oxford,

Bracken, Carroll, Harrison,

Adams, Brown, Champaigne,

Preble, and Shelby counties

Buckfield, East Waterford,

Gardiner, Greene, Hebron,

Paris, Turner, Wales, Wayne,

West Gardiner, and Winthrop

localities.

Lincoln, Quay, Colfax, Curry,

Roosevelt, Chavez, Northern

as well as additional Zip Codes

to cover the entire counties of

Rio Arriba, Torrence, Harding,

San Miguel, Mora, Guadalupe,

and Dona Ana.

All of Maine

The counties of Mendocino,

Bernadino and San Luis Obispo
ATTACHMENT 10

TX PacifiCare of Texas GF The entire counties of Atacosa,

OH Healthsource Ohio 3H Entire counties of Cuyahoga,

TN Healthsource Tennessee HT Clairborne county has been

MA Fallon Community Health JV Additional towns have been

MA Healthsource CMHC J1 Cities and towns have been

Plan added to the counties of: Essex,

Bandera, Comal, Medina and

Guadalupe

Geauga, Lake,

Lorain, Medina, Portage, Stark,

Summit, Wayne, Allen, Auglaize,

Shelby, Champaign, Preble,

Butler, Hamilton, Clermont and

Brown and the partial counties of:

Ashland - 44866, 44287,44691,

44859, 44880; Ashtabula -

44099; Erie -44809,

44839,44846, 44816, 44814;

Huron - 44857,44826, 44889;

Trumbull - 44062, 44491, 44444,

44430, 44470

added to the Knoxville service

area; Franklin county has been

added to the Chattanooga

service area; Nashville has been

added to the service area with

the following counties:

Cheatham, Davidson, Wilson

and Williamson. 

Middlesex, Suffolk, and Norfolk.

Please refer to brochure for

names.

added in Essex and Middlesex

counties. Please refer to

brochure for names.
ATTACHMENT 10

PA Geisinger Health Plan N9 All of Blair, Cambria, Huntingdon,

WA Group Health Cooperative of 54

ID Group Health Northwest VR counties

TN Heritage National Healthplan 4T

AR United HealthCare of QC Columbia, Craighead, Crittenden,

MS United HealthCare of QV Smith, Tunica, Walthall, and

TN United HealthCare of QR Cumberland, Decatur, Hardin,

IN Maxicare Indiana, Inc. GK Lawrenceberg/Greensberg area,

FL United HealthCare of QK

Puget Sound

of Tennessee, Inc.

Arkansas, Inc. Hempstead, Madison, Miller,

Mississippi, Inc. Warren counties

Tennessee, Inc. Knox, Lake, Loudon, Meigs,

Florida

Monroe, and Tioga counties; and

the following zip codes for

Bedford county: 15521, 15554,

16614, 16633, 16650, 16655,

16659, 16664, 16667, 16670,

16672, 16679, and 16695

All of Mason county

Benewah, and Shoshone

City of Bristol

Ashley, Benton, Chicot,

Pike, Sevier, and Washington

counties

Hinds, Leake, Madison, Rankin,

Anderson, Benton, Bledsoe,

Perry, Polk, Rhea, Roane, and

Sequatchie counties

Counties in

Jeffersonville/New Albany area,

Evansville area

Orlando, FL area
ATTACHMENT 10

CA FHP Health Plan CY The Southern California counties

TX FHP of New Mexico P2 El Paso and Hudspeth Counties

AR American HMO Health Plan- RB Arkansas, Ashley, Baxter,

IL American HMO Health Plan- AC Jackson, LaSalle, Madison,

VA HMO Virginia X8 Orange, Spotsylvania, Stafford,

PA Keystone Health Plan West ZT Clarion, Crawford, Forest,

PA Keystone Health Plan West ZU Clearfield, Huntingdon, and

NJ AmeriHealth HMO FK All of New Jersey is now covered

Arkansas Boone, Calhoun, Carroll, Clay,

Illinois Marion, McHenry, Randolph,

of Santa Barbara, San Luis

Obispo, Kern, Kings, and Tulare

have added additional Zip

Codes.

Conway, Dallas, Desha, Drew,

Greene, Howard, Independence,

Jackson, Marion, Nevada,

Oachita, Perry, Poinsett, Polk,

Pope, Sevier, Sharp, Stone, Van

Buren and Yell counties

Rock Island, Saline, St. Clair,

and Williamson counties

King George, Westmoreland, and

Richmond counties, and the city

of Fredericksburg

McKean, and Venango counties

Jefferson counties
ATTACHMENT 10

MI Care Choices KZ Most of Oakland, Genesee, and

MI M-Care EG All of Ingham and Eaton counties

TX HMO Texas, L.C. 2T Orange counties, as well as the

WV Carelink 4C Preston, Summers, Upshur,

OH Community Health Plan of MG Clermont, Clinton, Fayette,

AR Healthsource Arkansas 1H Miller counties)

Ohio (formerly Licking Gallia, Green, Guernsey,

Memorial Hospital HP) Harrison, Highland, Hocking,

Jackson counties, and portions

of Lapeer, Saginaw,

Shiawassee, Calhoun, and

Lenawee counties are now

covered

 

are now covered, and additional

portions of Jackson and Saginaw

counties have been added

Grimes, Harding, Jefferson, and

remaining zip codes in Austin,

Brazoria, Chambers, Colorado,

Liberty, Matagorda, Montgomery,

San Jacinto, Waller, and

Wharton counties

Calhoun, Mason, Monroe,

Wood, and Wyoming counties

Athens, Belmont, Brown, Butler,

Holmes, Jackson, Lawrence,

Marion, Meigs, Monroe, Morgan,

Morrow, Noble, Pickaway, Pike,

Richland, Ross, Scioto,

Tuscarawas, Union, Vinton,

Waren, and Washington counties

Van Buren County; (services are

now available in Hempstead,

Howard, Little River, Lincoln, and
ATTACHMENT 10

CO HMO Colorado/Nevada L2 All counties in CO except

NV HMO Colorado/Nevada VS All of Clark County is now

TX Scott & White UF All of Bastrop, Blanco, Bosque,

LA Gulf South Health Plans, Inc. LY Parish, which was inadvertently

VA U.S. Healthcare of Virginia 1U Hanover, and Henrico, and the

GA U.S. Healthcare of Georgia 2U McDuffie, Peach, Pulaski,

MD U.S. Healthcare of Delaware US Wicomico counties

Dolores, Eagle, Garfield,

Gunnison, Hinsdale, Jackson,

Moffat, Montezuma, Ouray,

Pitkin, Rio Blanco, Routt, San

Juan, and Summit

covered

Burnet, Caldwell, Falls, Grimes,

Hamilton, Hays, Hill, Hood,

Johnson, Lampasas, Lee, Llano,

Madison, McLennan, Milam,

Mills, Robertson, San Saba,

Somervell, Travis, Walker,

Washington, and Williamson

counties are now covered, as

well as portions of Austin, Erath,

Leon, and Waller counties (see

brochure for Zip Codes)

St. Mary Parish; Lafourche

omitted from the Plan's 1996

brochure, will be shown as

covered

The counties of Chesterfield,

cities of Hopewell, Petersburg,

and Richmond

Burke, Glascock, Hall, Lincoln,

Taliaferro, Twiggs, Walton, and

Warren counties

Kent, Talbot, Washington, and
ATTACHMENT 10

PA U.S. Healthcare of KL Erie, Lebanon, Northumberland,

OH DayMed Health Maintenance Q3 Cuyahoga and Summit counties

TN HMOBlue (formerly 6C Coffee, Grainger, Grundy, Meigs,

VA Chesapeake HP BL Northern Virginia

MD Chesapeake HP BL Frederick County

NJ NYLCare HPs New York HK Southern New Jersey

CT NYLCare HPs New York HV Fairfield County

TX NYLCare HPs of the V2 Several East Texas Counties

TX PCA HPs of Texas TW Several Dallas/Houston area

VA Southern Health Services 5S The counties of King George,

FL Humana Medical Plan EE Charlotte, Collier, DeSota,

Pennsylvania Pike, Snyder, and Susquehanna

Plan

CareChoice) and Putnam counties

(formerly Sanus HP)

(formerly Sanus HP)

Southwest (formerly Sanus

Texas HP)

counties

counties

Spotsylvania, Stafford, and

Westmoreland, and the city of

Fredericksburg

Glades, Hardee, Highlands,

Indian River, Lee, Martin,

Monroe, Okeechobee, and St,

Lucia counties
ATTACHMENT 10

MN HealthPartners HQ South Central and Southeastern

ND HealthPartners HQ Fargo/Moorhead area

ND HealthPartners Select 53 Fargo/Moorhead areas

MN HealthPartners Select 53 South Central and Southeastern

PA First Priority Health C8 Tioga County

GA BlueChoice Healthcare Plan 1B Cities of Atlanta, Gainesville,

IL Humana Health Chicago GQ Kankakee County

NV Humana Health Plan TL Carson City

KY Humana Health Plan D2 Breathitt, Laurel, Mason, Owsley,

TX Humana Health Plan of Texas UE Bastrop and Caldwell counties

CT 1S added in New Haven, Fairfield,

CA SJ San Luis Obispo, and Shasta.

(formerly MedCenters Health Minnesota

Plan)

(formerly MedCenters Health

Plan)

(formerly Group Health, Inc.)

(formerly Group Health, Inc.) Minnesota

Suburban Health Plan Additional towns have been

Blue Shield of CA HMO Entire counties of Kings, Madera,

Macon, Rome, and Cartersville

and Wolfe counties

have added additional Zip Codes

and Litchfield counties

Western portions of Fresno

County, and Zip Codes in

western and central portions of

Tulare County. 
ATTACHMENT 10

IN Prudential HealthCare HMO- 2I The counties of Clay, Clinton,

NM Lovelace Health Plan Q1 covered

MI Blue Care Network-Health LN Somerset and Wright townships

TN Prudential HealthCare HMO- UB and Tipton counties

MS Prudential HealthCare HMO- UB counties

NY WellCare of New York ZV

OH Prudential HealthCare HMO- AY Muskingum counties; and

MO Prudential HealthCare HMO- VZ Montgomery counties

IL Prudential HealthCare HMO- VZ

Indiana Howard, Madison, Monroe,

Central and Waldron Village)

Memphis

Memphis

Central Ohio portions of Morrow County

St. Louis

St. Louis

Montgomery, Parke, Putnam,

Sullivan, Tippecanoe, and Vigo;

additional areas in Shelby

County; and portions of Benton,

Brown, Carroll, Cass, Fountain,

Greene, Henry, Vermillion,

Warren, and White counties

All of New Mexico is now

Hillsdale County (except for

Fayette, Haywood, Lauderdale,

Desoto, Tate, and Tunica

Broome County

Coshocton, Knox, Logan, and

Portions of Audrain and

Portions of Calhoun County
ATTACHMENT 11

PLAN MERGERS

Enrollees in these plans will be transferred automatically to the surviving plan

unless they choose a different health plan during open season.

Merging Plans Code Surviving Plan Code

Dreyer HMO EU BCI HMO 3B

BCI HMO 3B

OPTIMA Health Plan V9 OPTIMA Health V9

Sentara Health Plan V5 Plan

Potomac Health Plan JM CareFirst Health JQ

CareFirst Health Plan JQ Plan
ATTACHMENT 12

PLAN NAME CHANGES

Note: Prudential's marketing name is now: Prudential HealthCare HMO. Prudential

HealthCare HMO replaces PruCare, Prudential Options, Prudential Health Care and

Prudential Health Plan references.

State Old Plan Name Code New Plan Name

NM Presbyterian Health Plus W8 Presbyterian Health Plan

RI,MA Harvard Community Health 70 Harvard Pilgrim Health Care of

MA Central Massachusetts J1 Healthsource CMHC 

KY Lexington Health Advantage XW Advantage Care, Inc. 

OH QualChoice HMO 1Q QualChoice Health Plan

AL Complete Health of Alabama, NY,NJ,NL United HealthCare of AlabamaAR Complete Health of Arkansas, QC United HealthCare of Arkansas,

MS Complete Health of QV United HealthCare of Mississippi,

TN Complete Health of QR United HealthCare of

NY Empire Blue Cross Blue 5K,5L,S7 BlueChoice HMO

OH Licking Memorial HP MG Community HP of Ohio

FL CareFlorida Health Plan 5C,5D,5E Foundation Health

WI HMO Midwest CV Atrium Health Plan

Plan - New Eng New England

Health Plan 

HP 

Inc. FQ, Inc.

Inc. Inc.

Mississippi, Inc. Inc.

Tennessee, Inc. Tennessee, Inc.

Shield HEALTHNET (Formerly

S1,S2,S7)
ATTACHMENT 12

RI HMO Rhode Island DA Coordinated Health Partners,

TX MetraHealth Care Plan, Inc. U3 MetraHealth Care Plan of Texas,

NY BlueCare Plus AH HMO Blue

FL CAC-United Healthcare Plans QK,1X United Healthcare of Florida

NY Foundation Health Plan CE,4E HMO-CNY

NY IDHP EB HMO-CNY

NY ChoiceCare J6 Vytra Healthcare

ID Idaho Preferred Healthcare GM,ZK,ZL Blue Cross of Idaho Coordinated

MO,IL MetraHealth Care Plans of St. 12 Principal Healthcare of St. Louis

IL,IN Aetna HP of IL, Inc. XC Aetna HP of the Midwest

IL Sanus HP of Illinois XA NYLCare HPs of the Midwest

DC, HealthPlus JN NYLCare HPs of the Mid-Atlantic

MD,

VA

NJ, Sanus Health Plan HK, HV

NY

TX Sanus Texas Health Plan V2

TX Sanus Health Plan UM, ZE,

MN, Group Health, Inc. 53

ND,

WI

of Florida

Louis

ZF

Inc. dba Blue CHiP/Coordinated

Health Partners, Inc.

Inc.

Care Services

NYLCare HPs of New York

NYLCare HPs of the Southwest

NYLCare HPs of the Gulf Coast

HealthPartners Select
ATTACHMENT 12

PA HMO of Northeastern PA C8 First Priority Health

PA Keystone Health Plan West EF/ZT/ZU KeystoneBlue

MO,IL GenCare Health Systems H8 United HealthCare Select

MO Physicians Health Plan of VB United HealthCare Choice

PA,NJ Greater Atlantic Health 27, 2K QualMed Plans for Health

TN CareChoice 6C HMOBlue

MN, MedCenters Health Plan HQ HealthPartners

ND,

WI

WI Wisconsin Health X1 Humana Wisconsin Health

Greater St. Louis

Service

Organization Organization
ATTACHMENT 13

ENROLLMENT CODE CHANGES

Enrollees in these plans will be transferred automatically to the new enrollment

code unless they choose a different health plan during open season.

Plan Name Old Code New Code

ExclusiCare (Iowa and Nebraska) XG 9Y

Antero Health Plans- ZD 9X

formerly ExclusiCare (Colorado)

BACE YU YD