Attachment 3 - FEHB Plan List. OPM\ISP\PPEG [email protected] (202) Carrier Code Subcode. Brochure Number Plan Name Carrier Code Location

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1 Carrier Code Carrier Code Subcode Brochure Number Plan Name Carrier Code Location FFS-AA Blue Cross and Blue Shield Service Benefit Plan Nationwide FFS-AZ Blue Cross and Blue Shield Service Benefit Plan Local Plan - Arizona FFS-CA Blue Cross and Blue Shield Service Benefit Plan Local Plan - California FFS-DC Blue Cross and Blue Shield Service Benefit Plan Local Plan - District of Columbia FFS-FL Blue Cross and Blue Shield Service Benefit Plan Local Plan - Florida FFS-IL Blue Cross and Blue Shield Service Benefit Plan Local Plan - Illinois FFS-MD Blue Cross and Blue Shield Service Benefit Plan Local Plan - Maryland FFS-TX Blue Cross and Blue Shield Service Benefit Plan Local Plan - Texas FFS-VA Blue Cross and Blue Shield Service Benefit Plan Local Plan - Virginia FFS-AA Blue Cross and Blue Shield Service Benefit Plan Nationwide FFS-AZ Blue Cross and Blue Shield Service Benefit Plan Local Plan - Arizona FFS-CA Blue Cross and Blue Shield Service Benefit Plan Local Plan - California FFS-DC Blue Cross and Blue Shield Service Benefit Plan Local Plan - Distric of Columbia FFS-FL Blue Cross and Blue Shield Service Benefit Plan Local Plan - Florida FFS-IL Blue Cross and Blue Shield Service Benefit Plan Local Plan - Illinois FFS-MD Blue Cross and Blue Shield Service Benefit Plan Local Plan - Maryland FFS-TX Blue Cross and Blue Shield Service Benefit Plan Local Plan-Texas FFS-VA Blue Cross and Blue Shield Service Benefit Plan Local Plan - Virginia HMO-IL Unicare HMO Chicagoland Area HMO-IN Unicare HMO Lake/Porter Counties HMO-AK Aetna HealthFund Anchorage and Fairbanks Areas HMO-AL Aetna HealthFund Choctaw/Lamar/Pickens/Sumter Counties HMO-AR Aetna HealthFund Little Rock Area and Eastern Arkansas HMO-AZ Aetna HealthFund Phoenix and Tucson Areas HMO-CA Aetna HealthFund Northern/Central Valley/Southern CA HMO-CO Aetna HealthFund Denver Area HMO-CT Aetna HealthFund All of Connecticut HMO-DC Aetna HealthFund All of Washington DC HMO-DE Aetna HealthFund All of Delaware HMO-FL Aetna HealthFund Most of Florida HMO-GA Aetna HealthFund Atlanta/Augusta/Savannah and NW GA HMO-ID Aetna HealthFund Kootenai County HMO-IL Aetna HealthFund Chicago Area/Eastern/Northern/SW IL HMO-IN Aetna HealthFund Evansville/Ft. Wayne/Indianapolis/SE IN HMO-KS Aetna HealthFund Kansas City Area and Southeastern KS HMO-KY Aetna HealthFund Lexington/Louisville/Eastern/Northern KY HMO-LA Aetna HealthFund BatonRouge/Lafayette/NewOrleans/Shrevept

2 22 22-HMO-MA Aetna HealthFund Most of Massachusetts HMO-MD Aetna HealthFund All of Maryland HMO-ME Aetna HealthFund All of Maine HMO-MI Aetna HealthFund Detroit Area/Central/Western MI HMO-MO Aetna HealthFund Columbia/Jeff.Cy/Joplin/KC/StLouis/Spfd HMO-MS Aetna HealthFund Gulfport/Jackson/Vicksburg/Northern MS HMO-NC Aetna HealthFund Ralgh/Durhm/Charlot/Win-Sal/Central NC HMO-NH Aetna HealthFund Most of New Hampshire HMO-NJ Aetna HealthFund All of New Jersey HMO-NV Aetna HealthFund Las Vegas/Clark and Nye Counties HMO-NY Aetna HealthFund NY City Area/Upstate NY (Roch. & Syr.) HMO-OH Aetna HealthFund Cincinnati/Cleveland/Columbus/Toledo HMO-OK Aetna HealthFund Oklahoma City and Tulsa Areas HMO-PA Aetna HealthFund Phil/Pitts/Lehigh Vlly/Cent/NE/SE PA HMO-SC Aetna HealthFund Aiken/Barnwell/Edgefield/York Counties HMO-TN Aetna HealthFund Memph/Nash/Chatnooga/Jcksn/Knox/Tri-City HMO-TX Aetna HealthFund Central/Northern/Southern/Western TX HMO-VA Aetna HealthFund Hamptn Rds/Norflk/Rich/Roank/No/Cent/SW HMO-WA Aetna HealthFund Seattle/Puget Sound/Spokane(Eastern WA) HMO-WV Aetna HealthFund Most of West Virginia HMO-PA HealthAmerica Pennsylvania Greater Pittsburgh area 2C 2C-POS-VA Piedmont Community Healthcare Lynchburg area 2G 2G-HMO-DC CareFirst BlueChoice Washington, D.C. Metro Area 2G 2G-HMO-MD CareFirst BlueChoice All of Maryland 2G 2G-HMO-VA CareFirst BlueChoice Northern Virginia 2J 2J-HMO-DE Coventry Health Care Most of Delaware 2J 2J-HMO-NJ Coventry Health Care Southern New Jersey 2L 2L-HMO-NV Health Plan of Nevada Northern Area 2N 2N-HMO-OK PacifiCare of Oklahoma Central/Northeastern Oklahoma 2U 2U-HMO-GA Aetna Open Access Atlanta and Athens Areas 2X 2X-HMO-CA Aetna Open Access Los Angeles and San Diego Areas FFS-AA GEHA Benefit Plan Nationwide FFS-AA NALC Nationwide FFS-AA GEHA High Deductible Health Plan Nationwide FFS-AA PBP Health Plan nationwide FFS-AA Rural Carrier Benefit Plan XXX 3A 3A-HMO-OH AultCare HMO Stark/Carroll/Holmes/Tuscarawas/Wayne Co. 3N 3N-HMO-FL Vista Healthplan South Florida 3U 3U-HMO-KY United Healthcare of Ohio, Inc. Northern Kentucky 3U 3U-HMO-OH United Healthcare of Ohio, Inc. Cincinnati/Dayton/Springfield areas

3 40 40-FFS-AA Foreign Service Benefit Plan XXX FFS-AA Association Benefit Plan XXX FFS-AA Association Benefit Plan XXX FFS-AA Panama Canal Area Benefit Plan XXX FFS-AA SAMBA Nationwide FFS-AA Mail Handlers Benefit Plan Nationwide FFS-AA APWU Health Plan Nationwide FFS-AA Mailhandlers Benefit Plan Consumer Option Nationwide 4N 4N-HMO-PA HealthAmerica Pennsylvania Northeast Pennsylvania HMO-NY HIP of Greater New York New York City area HMO-MI Health Alliance Plan Southeastern Michigan/Flint area HMO-IA HealthPartners Classic/Open Access Deductible Iowa HMO-MN HealthPartners Classic/Open Access Deductible Minnesota HMO-ND HealthPartners Classic/Open Access Deductible North Dakota HMO-SD HealthPartners Classic/Open Access Deductible South Dakota HMO-WI HealthPartners Classic/Open Access Deductible Wisconsin HMO-WA Group Health Cooperative Most of Western Washington HMO-OR Kaiser Foundation Health Plan of Northwest Portland/Salem areas HMO-WA Kaiser Foundation Health Plan of Northwest Vancouver/Longview HMO-CA Kaiser Foundation Health Plan of California Northern California 5E 5E-HMO-FL Vista Healthplan of South Florida Southern Florida 5M 5M-HMO-OH SuperMed HMO Northeast Ohio 5W 5W-HMO-OH SummaCare Health Plan Cleveland, Akron and Canton areas HMO-CA Kaiser Foundation Health Plan of California Southern California HMO-HI Kaiser Foundation Health Plan of Hawaii Islands of Hawaii/Kauai/Maui/Oahu HMO-OH Kaiser Foundation Health Plan of Ohio Cleveland/Akron areas HMO-CO Kaiser Foundation Health Plan of Colorado Denver/Colorado Springs areas 6J 6J-HMO-TN Aetna Open Access Nashville Area 6N 6N-HMO-KY Humana CoverageFirst (Consumer Driven Plan) Lexington 6Q 6Q-HMO-CA Universal Care Southern California 6U 6U-HMO-TX Firstcare Waco area 6V 6V-HMO-NY GHI HMO Select Brnx/Brklyn/Manhat/Queen/Richmon/Westche 6Y 6Y-HMO-IN Advantage Health Solutions, Inc. Most of Indiana HMO-IL Unicare HMO Chicagoland Area HMO-IN Unicare HMO Lake/Porter Counties HMO-IL Humana Health Plan Inc. Chicago area HMO-IN Humana Health Plan Inc. Lake/Porter/LaPorte Counties HMO-IL Union Health Service Chicago area 7D 7D-HMO-OH Aetna Open Access Cleveland and Toledo Areas 7G 7G-HMO-KS Coventry Health Care of Kansas, Inc. (HDHP) Wichita/Salina areas 7M 7M-POS-IL Mercy Health Plans Southwest Illinois

4 7M 7M-POS-MO Mercy Health Plans East/Central/Southwest Missouri 7T 7T-HMO-CO Humana CoverageFirst (Consumer Driven Plan) Denver 7W 7W-HMO-KS Coventry Health Care of Kansas-Wichita/Salinas Wichita/Salina areas 7Z 7Z-HMO-OR PacifiCare Northwest Region (Oregon/Washington) Metro Portland/Salem/Corvalis/Eugene 7Z 7Z-HMO-WA PacifiCare Northwest Region (Oregon/Washington) Clark County POS-NJ GHI Health Plan Northern New Jersey POS-NY GHI Health Plan All of New York POS-HI HMSA All of Hawaii POS-PR Triple-S All of Puerto Rico 8G 8G-HMO-TX Aetna Open Access Houston Area 8J 8J-HMO-WA Aetna Open Access Seattle/Puget Sound Areas 8W 8W-HMO-PA UPMC Health Plan Western Pennsylvania area 9E 9E-HMO-CO Aetna Open Access Denver Area 9F 9F-HMO-IL OSF Health Plans, Inc. Central/Central-Northwestern Illinois 9G 9G-HMO-IL BlueCHOICE Madison and St. Clair counties 9G 9G-HMO-MO BlueCHOICE StLouis/Central/SW areas 9H 9H-HMO-KS Coventry Health Care of Kansas (Kansas City)-HDHP Kansas City Area 9H 9H-HMO-MO Coventry Health Care of Kansas (Kansas City)-HDHP Kansas City Area 9J 9J-HMO-LA Humana CoverageFirst (Consumer Driven Plan) New Orleans 9K 9K-HMO-UT Altius Health Plans Wasatch Front 9L 9L-HMO-LA Humana CoverageFirst (Consumer Driven Plan) Baton Rouge 9N 9N-HMO-PA Health America Pennsylvania-HDHP Southeastern Pennsylvania 9R 9R-HMO-VA Optima Health Plan Hampton Roads and Richmond areas 9S 9S-HMO-LA Humana CoverageFirst (Consumer Driven Plan) Shreveport A3 A3-HMO-AZ PacifiCare of Arizona Maricopa, Pima County & Apache Junction A7 A7-HMO-AZ Health Net of Arizona, Inc. Maricopa/Pima/Other AZ counties AD AD-HMO-GA Humana CoverageFirst (Consumer Driven Plan) Atlanta AH AH-HMO-NY HMO Blue Utica/Rome/Central New York areas AK AK-HMO-OH United Healthcare of Ohio, Inc. CLEVELAND AU AU-POS-IA Sioux Valley Health Plan Northwestern Iowa AU AU-POS-SD Sioux Valley Health Plan Eastern/Central/Rapid City Areas AV AV-HMO-IA Avera Health Plans Northwestern Iowa AV AV-HMO-NE Avera Health Plans North Central Nebraska AV AV-HMO-SD Avera Health Plans Eastern and Central South Dakota B9 B9-HMO-IL UnitedHealthcare of the Midwest Southwest llinois B9 B9-HMO-MO UnitedHealthcare of the Midwest St. Louis Area BJ BJ-HMO-LA Coventry Health Care of Louisiana New Orleans area BM BM-HMO-IN Humana CoverageFirst (Consumer Driven Plan) Southern Indiana BM BM-HMO-KY Humana CoverageFirst (Consumer Driven Plan) Louisville BP BP-HMO-FL Humana CoverageFirst (Consumer Driven Plan) Pensacola BT BT-HMO-TN Humana CoverageFirst (Consumer Driven Plan) Nashville BW BW-HMO-MI Humana CoverageFirst (Consumer Driven Plan) Detroit

5 CA CA-HMO-OH United Healthcare of Ohio, Inc. COLUMBUS CH CH-HMO-CO UnitedHealthcare of Colorado Colorado CK CK-HMO-TX Firstcare West Texas CY CY-HMO-CA PacifiCare of California Most of California D6 D6-HMO-CO PacifiCare of Colorado Metro Denver/Boulder/Colorado Springs DA DA-POS-MA Blue CHiP Coordinated Health Plan - BCBS of RI Southeastern Massachusetts DA DA-POS-RI Blue CHiP Coordinated Health Plan - BCBS of RI All of Rhode Island DB DB-HMO-AZ Humana CoverageFirst (Consumer Driven Plan) Phoenix DL DL-HMO-FL Humana CoverageFirst (Consumer Driven Plan) Daytona DQ DQ-HMO-IN Physicians Health Plan of Northern Indiana Northeast Indiana DV DV-HMO-MA Fallon Community Health Plan HDHP Central/Eastern Massachusetts E3 E3-HMO-DC Kaiser Foundation Health Plan Mid-Atlantic States Washington, DC area E3 E3-HMO-MD Kaiser Foundation Health Plan Mid-Atlantic States Baltimore/Washington, DC areas E3 E3-HMO-VA Kaiser Foundation Health Plan Mid-Atlantic States Washington, DC area EA EA-HMO-FL Capital Health Plan Tallahassee area EB EB-HMO-NY HMOBlue-CNY Syracuse/Binghamton/Elmira areas ED ED-HMO-PA Keystone Health Plan East Philadelphia area EE EE-HMO-FL Humana Medical Plan, Inc. South Florida EG EG-HMO-MI M-Care Southeastern Michigan and Flint area F8 F8-HMO-GA Kaiser Foundation Health Plan Of Geogria, Inc. Atlanta Area FB FB-HMO-WI Humana CoverageFirst (Consumer Driven Plan) Milwaukee FC FC-HMO-CO Humana CoverageFirst (Consumer Driven Plan) Colorado Springs FK FK-HMO-NJ AmeriHealth HMO All of New Jersey FT FT-HMO-MI Humana CoverageFirst (Consumer Driven Plan) Most of Michigan FX FX-HMO-IA Health Alliance HMO Central Iowa FX FX-HMO-IL Health Alliance HMO Central/E.Central/N.West/South/West IL FX FX-HMO-IN Health Alliance HMO Western Indiana G2 G2-HMO-IN Arnett HMO Lafayette area GA GA-HMO-NY MVP Health Care Eastern Region GE GE-HMO-IL PersonalCares HMO Central Illinois GF GF-HMO-TX Pacificare of Texas San Antonio, Dallas/Ft. Worth GT GT-HMO-MI Humana CoverageFirst (Consumer Driven Plan) Grand Rapids GV GV-HMO-NY Preferred Care Rochester area GW GW-HMO-GA Kaiser Foundation Health Plan of Georgia Inc. HDHP Atlanta Area GX GX-HMO-KS UnitedHealthcare of the Midwest Kansas City Area GX GX-HMO-MO UnitedHealthcare of the Midwest Kansas City Area GZ GZ-HMO-MD Coventry Health Care HDHP Most of Maryland HA HA-HMO-KS Coventry Health Care of Kansas-Kansas City Kansas City area HA HA-HMO-MO Coventry Health Care of Kansas-Kansas City Kansas City area HB HB-HMO-LA Coventry Health Care of Louisiana HDHP New Orleans area HM HM-POS-TX Mercy Health Plans Webb/Zapata/Duval/Jim Hogg Counties HQ HQ-HMO-MN HealthPartners Primary Clinic Plan Minneapolis/St. Paul/St. Cloud

6 HQ HQ-HMO-WI HealthPartners Primary Clinic Plan West Central Wisconsin HS HS-HMO-LA Coventry Health Care of Louisiana Shreveport area HZ HZ-HMO-IN Humana CoverageFirst (Consumer Driven Plan) Indianapolis IB IB-HMO-SC Carolina Care South Carolina IC IC-HMO-KS Community Health Plan New Comparison Guide Location IC IC-HMO-MO Community Health Plan Northwest Missouri IE IE-HMO-NE Coventry Health Care of Nebraska Omaha and Lincoln Metropolitan areas IG IG-HMO-MD Coventry Health Care Most of Maryland IK IK-HMO-IL Aetna Open Access Chicago Area IK IK-HMO-IN Aetna Open Access Northern Indiana IM IM-HMO-OK Globalhealth, Inc. Oklahoma IN IN-HMO-IN M*Plan Indiana Metropolitan Area J6 J6-HMO-NY Vytra Health Plans Queens/Nassau/Suffolk Counties J8 J8-HMO-FL JMH Health Plan Broward-Dade counties JA JA-HMO-LA Coventry Health Care of Louisiana Baton Rouge area JC JC-HMO-CT Aetna Open Access All of Connecticut JC JC-HMO-NY Aetna Open Access NYC Area and Dutchess/Sullivan/Ulster JK JK-HMO-GU TakeCare Guam/N.Mariana Islands/Belau JK JK-HMO-GU TakeCare Guam/N.Mariana Islands/Belau JN JN-HMO-DC Aetna Open Access Washington, DC Area JN JN-HMO-MD Aetna Open Access Northern/Central/Southern Maryland JN JN-HMO-VA Aetna Open Access Northern/Central/Richmond Virginia Area JP JP-HMO-DC M.D. IPA Washington, DC area JP JP-HMO-MD M.D. IPA All of Maryland JP JP-HMO-VA M.D. IPA N.VA/Cntrl VA/Richmond/Tidewater/Roanoke JR JR-HMO-NJ Aetna Open Access Northern New Jersey JV JV-HMO-MA Fallon Community Health Plan Central/Eastern Massachusetts K5 K5-HMO-MI Bluecare Network of MI Midland County Area K9 K9-HMO-NV PacifiCare of Nevada Las Vegas/Clark County KQ KQ-HMO-NY Univera Healthcare Western New York (Southern Counties) KR KR-HMO-MI Bluecare Network of MI Kent County Area KS KS-HMO-KS Aetna Open Access Kansas City Area KS KS-HMO-MO Aetna Open Access Kansas City Area L1 L1-HMO-WA KPS Health Plans All of Washington L3 L3-HMO-LA Coventry Health Care of Louisiana HDHP Shreveport area L4 L4-HMO-OH HMO Health Ohio Northeast Ohio L5 L5-HMO-GA Coventry Health Care of Georgia HDHP Atlanta Greater Metropolitan Area L6 L6-HMO-TN Humana CoverageFirst (Consumer Driven Plan) Memphis L8 L8-HMO-IN Humana CoverageFirst (Consumer Driven Plan) Indiana L8 L8-HMO-KY Humana CoverageFirst (Consumer Driven Plan) Northern Kentucky L8 L8-HMO-OH Humana CoverageFirst (Consumer Driven Plan) Cincinnati

7 LB LB-HMO-CA Health Net of California Most of California LK LK-HMO-DE Coventry Health Care HDHP Most of Delaware LK LK-HMO-NJ Coventry Health Care HDHP Southern New Jersey LM LM-HMO-GA Humana CoverageFirst (Consumer Driven Plan) Macon LN LN-HMO-MI Bluecare Network of MI Mid Michigan LT LT-HMO-LA Coventry Health Care of Louisiana HDHP Baton Rouge area LX LX-HMO-MI Bluecare Network of MI Southeast MI M5 M5-HMO-CA Blue Cross- HMO Most of California M9 M9-HMO-NY MVP Health Care Central Region MJ MJ-HMO-FL Humana CoverageFirst (Consumer Driven Plan) Tampa MK MK-HMO-NY Blue Choice Rochester area ML ML-HMO-FL Av-Med Health Plan Broward, Dade and Palm Beach MM MM-HMO-IL Group Health Plan, Inc. Southern/Central MM MM-HMO-MO Group Health Plan, Inc. St. Louis Area MQ MQ-HMO-FL Humana CoverageFirst (Consumer Driven Plan) Jacksonville MS MS-HMO-KS Humana Health Plan, Inc. Kansas City area MS MS-HMO-MO Humana Health Plan, Inc. Kansas City area MV MV-HMO-LA Vantage Health Plan, Inc. Monroe/Shreveport/Alexandria Areas MW MW-HMO-IL Humana CoverageFirst (Consumer Driven Plan) Chicago MW MW-HMO-IN Humana CoverageFirst (Consumer Driven Plan) Lake/Porter/LaPorte Counties MX MX-HMO-NY MVP Health Care Mid-Hudson Region MZ MZ-HMO-OH Hometown Health Plan Massillon ND ND-HMO-OH Aetna Open Access Columbus Area NM NM-HMO-NV Health Plan of Nevada Las Vegas area NV NV-HMO-MT New West Health Services Most of Montana P1 P1-HMO-TX Aetna Open Access Austin/San Antonio Areas P2 P2-HMO-NM Presbyterian Health Plan All NM counties except Otero & S. Eddy P3 P3-HMO-NJ Aetna Open Access Southern New Jersey P3 P3-HMO-PA Aetna Open Access Philadelphia and Southeastern PA PH PH-HMO-KS Humana CoverageFirst (Consumer Driven Plan) Kansas City PH PH-HMO-MO Humana CoverageFirst (Consumer Driven Plan) Kansas City PN PN-HMO-PA HealthAmerica Pennsylvania Southeastern Pennsylvania PU PU-HMO-TX Aetna Open Access Dallas/Ft Worth Areas PV PV-HMO-WY WINhealth Partners Wyoming Q1 Q1-HMO-NM Lovelace Health Plan All of New Mexico Q8 Q8-HMO-NY Univera Healthcare Western New York (Northern Counties) QA QA-HMO-NY Independent Health Assoc Western New York QP QP-HMO-FL Humana CoverageFirst (Consumer Driven Plan) South Florida R5 R5-HMO-OH Blue HMO Most of Ohio RD RD-HMO-IN Aetna Open Access Southeastern Indiana RD RD-HMO-KY Aetna Open Access Northern Kentucky RD RD-HMO-OH Aetna Open Access Greater Cincinnati Area

8 RL RL-HMO-MI Grand Valley Health Plan Grand Rapids area RU RU-HMO-ND Heart of America Health Plan Northcentral North Dakota S4 S4-HMO-PA Keystone Health Plan Central Harrisburg/Northern Region/Lehigh Valley SA SA-HMO-WA PacifiCare Northwest Region (Oregon/Washington) Washington SG SG-HMO-NY CDPHP Universal Benefits, Inc. Capital District area SJ SJ-HMO-CA Blue Shield of CA Access+HMO Most of California SL SL-HMO-OK Aetna Open Access Oklahoma City/Tulsa Areas SV SV-HMO-IA Coventry Health Care of Iowa Central & Eastern Iowa/Sioux City SW SW-HMO-PA HealthAmerica Pennsylvania Central Pennsylvania T2 T2-HMO-TX Humana CoverageFirst (Consumer Driven Plan) Houston T8 T8-HMO-TX Humana CoverageFirst (Consumer Driven Plan) Dallas/Ft. Worth TE TE-HMO-CT ConnectiCare All of Connecticut TE TE-HMO-MA ConnectiCare Counties Hampden, Hampshire, Franklin TP TP-HMO-TX Humana CoverageFirst (Consumer Driven Plan) Corpus Christi TU TU-HMO-TX Humana CoverageFirst (Consumer Driven Plan) San Antonio TV TV-HMO-TX Humana CoverageFirst (Consumer Driven Plan) Austin U2 U2-HMO-OH Paramount Health Care Northwest/North Central Ohio U4 U4-HMO-OH The Health Plan of the Upper Ohio Valley Eastern Ohio U4 U4-HMO-WV The Health Plan of the Upper Ohio Valley Northern/Central West Virginia UB UB-HMO-TN Aetna Open Access Memphis Area UL UL-HMO-FL Vista Healthplan Gainesville UR UR-HMO-TX Humana Health Plan of Texas San Antonio area VA VA-HMO-KS Preferred Plus of Kansas S. Central Area VR VR-HMO-ID Group Health Cooperative Kootenai and Latah VR VR-HMO-WA Group Health Cooperative Central WA/Spokane/Pullman VT VT-HMO-WA KPS Health Plans All of Washington VW VW-HMO-VT MVP Health Care All of Vermont WD WD-HMO-WI Dean Health Plan South Central Wisconsin WJ WJ-HMO-WI Group Health Cooperative South Central Wisconsin WQ WQ-HMO-AZ Aetna Open Access Phoenix/Tucson Areas X4 X4-HMO-NY GHI HMO Select Capital/Hudson Valley Regions X5 X5-HMO-MI HealthPlus MI Flint/Saginaw areas Y1 Y1-HMO-NV Aetna Open Access Las Vegas Area Y6 Y6-HMO-PA Health America Pennsylvania-HDHP Greater Pittsburgh Area Y9 Y9-HMO-FL Vista Healthplan Tallahassee YE YE-HMO-PA Aetna Open Access Pittsburgh Area YG YG-HMO-FL Humana CoverageFirst (Consumer Driven Plan) Orlando YH YH-HMO-IA John Deere Health Plan Eastern Iowa YH YH-HMO-IL John Deere Health Plan West Central Illinois YM YM-HMO-TX HMO Blue Texas Houston YN YN-HMO-PA Health America Pennsylvania-HDHP Northeast Pennsylvania YW YW-HMO-PA Health America Pennsylvania-HDHP Central Pennsylvania

9 ZJ ZJ-HMO-PR Humana Health Plans of Puerto Rico, Inc. Puerto Rico