CONTRACT_ID|PLAN_ID|SEGMENT_ID|CONTRACT_NAME|PLAN_NAME|FORMULARY_ID|PREMIUM|DEDUCTIBLE|MA_REGION_CODE|PDP_REGION_CODE|STATE|COUNTY_CODE|SNP|PLAN_SUPPRESSED_YN
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36110|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36170|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36260|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36280|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36290|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36440|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36480|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36490|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36530|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36580|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36630|0|N
H0022|001|000|BUCKEYE COMMUNITY HEALTH PLAN, INC.|Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)|00025045|0.00|0| | |OH|36880|0|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28100|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28110|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28120|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28180|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28190|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28210|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28250|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28260|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28270|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28290|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28470|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28540|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28590|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28620|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28630|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28700|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28710|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28750|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28760|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28770|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28790|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28840|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28860|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28880|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28890|2|N
H0028|007|000|CHA HMO, INC.|Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)|00025456|50.60|590| | |NE|28920|2|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |IL|14020|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |IL|14060|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |IL|14130|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |IL|14500|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |IL|14680|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |IL|14900|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |MO|26030|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |MO|26090|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |MO|26130|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |MO|26270|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |MO|26350|0|N
H0028|014|000|CHA HMO, INC.|Humana Gold Plus H0028-014 (HMO)|00025458|0.00|250| | |MO|26460|0|N
