Advantage Plan MCO HHSC Contract Number CMS Code Plan ID Plan Name Type Counties Served Health Plan of Texas 529-16-0012-00001 H2649 045 Aransas, Bee, Jim Wells, Kleberg, Nueces, San Patricio Health Plan of Texas 529-16-0012-00001 H2649 046 Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson Health Plan of Texas 529-16-0012-00001 H2649 047 Bowie, Cass, Collin, Dallas, Delta, Denton, Ellis, Fannin, Johnson, Kaufman, Red River, Rockwall, Tarrant, Titus, Wise Health Plan of Texas 529-16-0012-00001 H2649 049 El Paso Health Plan of Texas 529-16-0012-00001 H2649 051 Hayes, Travis, Williamson Health Plan of Texas 529-16-0012-00001 H2649 801 Anderson, Aransas, Atascosa, Bandera, Bee, Bexar, Bowie, Camp, Cass, Cherokee, Collin, Comal, Dallas, Delta, Denton, Ellis, El Paso, Fannin, Fort Bend, Franklin, Freestone, Gregg, Guadalupe, Hardin, Harris, Harrison, Hays, Henderson, Hopkins, Houston, Jefferson, Jim Wells, Johnson, Kendall, Kleberg, Marion, Medina, Montgomery, Morris, Navarro, Nueces, Panola, Red River, Rockwall, Rusk, San Patricio, Shelby, Smith, Tarrant, Titus, Travis, Trinity, Upshur, Van Zandt, Williamson, Wilson, Wise, Wood Health Plan of Texas 529-16-0012-00001 H2649 802 (- CHF/DM Anderson, Aransas, Atascosa, Bandera, Bee, Bexar, Bowie, Camp, Cass, Cherokee, Collin, Comal, Dallas, Delta, Denton, Ellis, El Paso, Fannin, Fort Bend, Franklin, Freestone, Gregg, Guadalupe, Hardin, Harris, Harrison, Hays, Henderson, Hopkins, Houston, Jefferson, Jim Wells, Johnson, Kendall, Kleberg, Marion, Medina, Montgomery, Morris, Navarro, Nueces, Panola, Red River, Rockwall, Rusk, San Patricio, Shelby, Smith, Tarrant, Titus, Travis, Trinity, Upshur, Van Zandt, Williamson, Wilson, Wise, Wood Advantage Plans Page 1 of 6
Health Plan of Texas 529-16-0012-00001 H2649 803 (- CHF/DM Anderson, Aransas, Atascosa, Bandera, Bee, Bexar, Bowie, Camp, Cass, Cherokee, Collin, Comal, Dallas, Delta, Denton, Ellis, El Paso, Fannin, Fort Bend, Franklin, Freestone, Gregg, Guadalupe, Hardin, Harris, Harrison, Hays, Henderson, Hopkins, Houston, Jefferson, Jim Wells, Johnson, Kendall, Kleberg, Marion, Medina, Montgomery, Morris, Navarro, Nueces, Panola, Red River, Rockwall, Rusk, San Patricio, Shelby, Smith, Tarrant, Titus, Travis, Trinity, Upshur, Van Zandt, Williamson, Wilson, Wise, Wood Health Plan of Texas 529-16-0012-00001 H2649 052 Harris, Fort Bend, Montgomery Health Plan of Texas 529-16-0012-00001 H2649 053 Group Kleberg, Nueces, San Patricio Health Plan of Texas 529-16-0012-00001 H2649 054 Group Atascosa, Bandera, Bexar, Comal, Kendall, Wilson Health Plan of Texas 529-16-0012-00001 H2649 055 Group Anderson, Camp, Cherokee, Franklin, Freestone, Gregg, Hardin, Harrison, Henderson, Hopkins, Houston, Jefferson, Marion, Morris, Navarro, Panola, Rusk, Shelby, Smith, Trinity, Upshur, Van Zandt, Wood Insurance Company of Scott and White 529-16-0012-00005 H8237 001 Vital Traditions () Collin, Dallas, Ellis, Johonson, Rockwall, Tarrant Insurance Company of Scott and White 529-16-0012-00005 H8237 003 Vital Traditions ( POS) Collin, Dallas, Ellis, Johonson, Rockwall, Tarrant SelectCare Health Plans 529-16-0012-00002 H5656 001 Classic () Collin, Dallas, Rockwall, Tarrant SelectCare of Texas 529-16-0012-00003 H4506 003 Classic () Austin, Brazoria, Chambers, Fort Bend, Galveston (77510, 77511, 77517, 77518, 77539, 77546, 77549, 77563, 77564,77568, 77573, 77574, 77590, 77591, 77592), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Waller Advantage Plans Page 2 of 6
SelectCare of Texas 529-16-0012-00003 H4506 010 Value () Austin, Brazoria, Chambers, Fort Bend, Galveston (77510, 77511, 77517, 77518, 77539, 77546, 77549, 77563, 77564,77568, 77573, 77574, 77590, 77591, 77592), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Waller SelectCare of Texas 529-16-0012-00003 H4506 029 Choice Austin, Brazoria, Chambers, Fort Bend, Galveston (77510, 77511, 77517, 77518, 77539, 77546, 77549, 77563, 77564,77568, 77573, 77574, 77590, 77591, 77592), Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Waller Texas 529-16-0012-00004 H4513 009 Advantage Angelina, Brazoria, Cameron, Chambers, Fort Bend, Hardin, Harris, Hidalgo, Jasper, Jefferson, Liberty, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Tyler, Walker, Waller and Willacy. Galveston (77510; 77511; 7517; 77518; 77539; 77546; 77549; 77563; 77565; 77568; 77573; 77574; 77590; 77591; 77592) Texas 529-16-0012-00004 H4513 025 Advantage Brazoria, Cameron, Chambers, Fort Bend, Hardin, Harris, Hidalgo, Jasper, Jefferson, Liberty, Montgomery, Newton, Orange, San Jacinto, Walker, Waller, Webb, Willacy, Angelina, Nacogdoches, Polk, Tyler, Galveston (77510; 77511; 7517; 77518; 77539; 77546; 77549; 77563; 77565; 77568; 77573; 77574; 77590; 77591; 77592 ) Texas 529-16-0012-00004 H4528 001 Preferred Bexar, Collin, Dallas, Denton, El Paso, Hood, Johnson, Parker,Tarrant, Wise Texas 529-16-0012-00004 H2165 018 Preferred Henderson, Lubbock, Rusk, Smith, Upshur, Van Zandt Advantage Plans Page 3 of 6
Advantage Special Needs Plan MCO HHSC Contract Number Amerigroup 529-16-0013-00002 H5817 001 CMS Code Plan ID Plan Name Type Counties Served Amerivantge Dual Coordination Bexar, ElPaso, and Travis Amerigroup 529-16-0013-00002 H5817 002 Amerivantge Dual Coordination Harris Amerigroup 529-16-0013-00002 H5817 003 Amerivantge Dual Coordination Brazoria, Fort Bend, Galveston, Jefferson, Montgomery, Denton, Tarrant, Hudspeth, Comal, Medina, Lubbock, Hays, and Williamson Care Improvement Plus 529-16-0013-00005 R6801 011 Dual Advantage All Counties Care Improvement Plus 529-16-0013-00005 H0084 005 Dual Advantage All Counties FirstCare 529-16-0013-00006 H4525 003 FirstCare Advantage Select Crosby, Ector, Floyd, Garza, Hale, Hockley, Jones, Lamb, Lubbock, Lynn, Midland, Potter, Randall, Taylor, Terry, Tom Green, Hill, DeafSmith, Carson, Swisher, Castro, Martin, McLennan, Hutchinson, Bauiley, Dickens, Cochran GHS Insurance 529-16-0013-00010 H8133 009 Blue Cross AdvantageDual Care Bastrop, Burnet, Caldwell, Hays, Lee, Williamson, ElPaso Health Plan of Texas 529-16-0013-00007 H2649 048 Gold Plus -DE Bowie, Cass, Collin, Dallas, Delta, Denton, El Paso, Ellis, Fannin, Fort Bend, Gregg, Harris, Harrison, Henderson, Johnson, Montgomery, Red River, Rockwall, Tarrant, Titus, Wise Health Plan of Texas 529-16-0013-00007 H2649 050 Gold Plus -De Aransas, Atascosa, Bandera, Bee, Bexar, Comal, Guadalupe, Jim Wells, Kendall, Kleberg, Medina, Nueces, San Patricio, Wilson Molina of Texas, Inc 529-16-0013-00008 H7678 001 Molina Options Plus Bexar, Cameron, Collins, Dallas, ElPaso, Harris, Hidalgo, Webb Advantage Plans Page 4 of 6
Molina of Texas, Inc 529-16-0013-00008 H7678 002 Molina Options Bexar, Cameron, Collins, Dallas, ElPaso, Harris, Hidalgo, Webb 529-16-0013-00011 H4527 003 Hays, Travis Williamson 529-16-0013-00011 H4527 004 Aransas, Kleberg, Nueces, San Patricio 529-16-0013-00011 H4527 006 El Paso 529-16-0013-00011 H4527 015 Cameron, Hidalgo, Willacy Superior 529-16-0013-00012 H5294 001 Superior HealthPlan Advantage Bexar, Nueces, Dallas, Rockwall, Collin Texas 529-16-0013-00009 H4513 010 TotalCare Angelina, Brazoria, Cameron, Chambers, Fort Bend, Galveston (77510; 77511; 7517; 77518; 77539; 77546; 77549; 77563; 77565; 77568; 77573; 77574; 77590; 77591; 77592), Hardin, Harris, Hidalgo, Jasper, Jefferson, Liberty, Montgomery, Nacogdoches, Newton, Orange, Polk, San Jacinto, Shelby, Tyler, Walker, Waller, Webb, Willacy Texas 529-16-0013-00009 H4528 002 Cigna-Health Spring TotaCare Bexar, Collin, Dallas, Denton, El Paso, Hood, Johnson, Parker,Tarrant, Wise Texas 529-16-0013-00009 H2165 019 TotalCare Cherokee, Grayson, Gregg, Henderson, Lubbock, Rains, Rusk, Smith, Upshur, Van Zandt, Wood Today's Options 529-16-0012-00013 H0174 001 Star Austin, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, Polk, San Jacinto, Walker, Waller, Wharton Insurance Company 529-16-0013-00014 H2228 007 DP (PPO ) El Paso Advantage Plans Page 5 of 6
of Texas, LLC 529-16-0013-00003 H4514 001 HealthCare Bastrop, Brazoria, Burnet, Caldwell, Fort Bend, Galveston, Harris, Hays, Henderson, Jefferson, Liberty, Montgomery, Polk, Smith, Travis, Van Zandt, Waller, Williamson, and Wood Benefits of Texas, Inc 529-16-0013-00001 H4590 020 Colin, Dallas, Denton, Ellis, Johnson, Kaufman, Rockwall, Tarrant, Benefits of Texas, Inc 529-16-0013-00001 H4590 022 Atascosa, Bexar, Comal, Guadalupe, Kendall, Wilson, Benefits of Texas, Inc 529-16-0013-00001 H4590 033 Bee, Jim Wells, Kleberg Nueces, San Patricia WellCare 529-16-0013-00004 H1264 018 WellCare Access ElPaso WellCare 529-16-0013-00004 H1264 007 WellCare Access Bexar, Dallas, Denton, Fort Bend, Galveston, Harris, Jefferson, Johnson, Montgomery, Tarrant Advantage Plans Page 6 of 6