Cambios a nuestra lista de medicamentos

No es muy común, pero durante el año, es probable que decidamos:

• Eliminar un medicamento de nuestra lista
• Agregar una autorización previa, requerimientos de terapia de fases y límites de cantidad a un medicamento.
• Mover un medicamento a un nivel de mayor costo

Si alguna de estas cosas ocurre con un medicamento que usted está tomando, le informaremos al menos 30 días antes de que el cambio tenga lugar.

Seleccione el nombre de su plan para ver los cambios recientes. Actualizamos estos documentos el primer día de cada mes.

Alabama:

• DEVOTED CHOICE 001 AL (PPO)
• DEVOTED CHOICE 002 AL (PPO)
• DEVOTED CHOICE GIVEBACK 005 AL (PPO)
• DEVOTED CHOICE GIVEBACK 006 AL (PPO)
• DEVOTED CORE 001 AL (HMO)
• DEVOTED C-SNP CHOICE 008 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE 010 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE PLUS 012 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE PLUS 015 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 009 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP)
• DEVOTED DUAL 004 AL (HMO D-SNP)
• DEVOTED DUAL 007 AL (HMO D-SNP)
• DEVOTED DUAL CHOICE FULL 013 AL (PPO D-SNP)
• DEVOTED DUAL CHOICE FULL 014 AL (PPO D-SNP)
• DEVOTED DUAL PLUS 003 AL (HMO D-SNP)
• DEVOTED DUAL PLUS 006 AL (HMO D-SNP)
• DEVOTED GIVEBACK 002 AL (HMO)

Arizona

• DEVOTED CHOICE 001 AZ (PPO)
• DEVOTED CHOICE 002 AZ (PPO)
• DEVOTED CHOICE 003 AZ (PPO)
• DEVOTED CHOICE GIVEBACK 006 AZ (PPO)
• DEVOTED CORE 001 AZ (HMO)
• DEVOTED CORE 007 AZ (HMO)
• DEVOTED CORE 016 AZ (HMO)
• DEVOTED CORE 020 AZ (HMO)
• DEVOTED CORE 021 AZ (HMO)
• DEVOTED C-SNP 011 AZ (HMO C-SNP)
• DEVOTED C-SNP 023 AZ (HMO C-SNP)
• DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP)
• DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP)
• DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP)
• DEVOTED GIVEBACK 013 AZ (HMO)
• DEVOTED GIVEBACK 019 AZ (HMO)

Arkansas

• All Plans

Colorado

• DEVOTED CHOICE 001 CO (PPO)
• DEVOTED CHOICE 002 CO (PPO)
• DEVOTED CHOICE 005 CO (PPO)
• DEVOTED CHOICE GIVEBACK 003 CO (PPO)
• DEVOTED CORE 001 CO (HMO)
• DEVOTED CORE 004 CO (HMO)
• DEVOTED C-SNP PLUS 013 CO (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 009 CO (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 010 CO (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP)
• DEVOTED DUAL 007 CO (HMO D-SNP)
• DEVOTED DUAL FULL 012 CO (HMO D-SNP)
• DEVOTED DUAL PLUS 003 CO (HMO D-SNP)

Delaware

• All Plans

Florida

• DEVOTED CHOICE 015 FL (PPO)
• DEVOTED CHOICE GIVEBACK 008 FL (PPO)
• DEVOTED CHOICE GIVEBACK 013 FL (PPO)
• DEVOTED CORE 001 FL (HMO)
• DEVOTED CORE 002 FL (HMO)
• DEVOTED CORE 003 FL (HMO)
• DEVOTED CORE 005 FL (HMO)
• DEVOTED CORE 025 FL (HMO)
• DEVOTED CORE 027 FL (HMO)
• DEVOTED CORE 029 FL (HMO)
• DEVOTED CORE 036 FL (HMO)
• DEVOTED CORE 046 FL (HMO)
• DEVOTED CORE 050 FL (HMO)
• DEVOTED CORE 056 FL (HMO)
• DEVOTED CORE 057 FL (HMO)
• DEVOTED CORE 058 FL (HMO)
• DEVOTED CORE 059 FL (HMO)
• DEVOTED CORE 060 FL (HMO)
• DEVOTED CORE 061 FL (HMO)
• DEVOTED CORE 062 FL (HMO)
• DEVOTED CORE 063 FL (HMO)
• DEVOTED CORE 064 FL (HMO)
• DEVOTED CORE 065 FL (HMO)
• DEVOTED CORE 066 FL (HMO)
• DEVOTED C-SNP PLUS 084 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 085 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 086 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 087 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 088 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 089 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 090 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 091 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 067 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 068 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 070 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 071 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 073 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 074 FL (HMO C-SNP)
• DEVOTED DUAL 019 FL (HMO D-SNP)
• DEVOTED DUAL 020 FL (HMO D-SNP)
• DEVOTED DUAL 021 FL (HMO D-SNP)
• DEVOTED DUAL 022 FL (HMO D-SNP)
• DEVOTED DUAL 023 FL (HMO D-SNP)
• DEVOTED DUAL 024 FL (HMO D-SNP)
• DEVOTED DUAL 033 FL (HMO D-SNP)
• DEVOTED DUAL 034 FL (HMO D-SNP)
• DEVOTED DUAL 039 FL (HMO D-SNP)
• DEVOTED DUAL 041 FL (HMO D-SNP)
• DEVOTED DUAL 043 FL (HMO D-SNP)
• DEVOTED DUAL FULL 077 FL (HMO D-SNP)
• DEVOTED DUAL FULL 078 FL (HMO D-SNP)
• DEVOTED DUAL FULL 079 FL (HMO D-SNP)
• DEVOTED DUAL FULL 080 FL (HMO D-SNP)
• DEVOTED DUAL FULL 081 FL (HMO D-SNP)
• DEVOTED DUAL FULL 082 FL (HMO D-SNP)
• DEVOTED DUAL FULL 083 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 042 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 052 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 053 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 054 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 055 FL (HMO D-SNP)
• DEVOTED GIVEBACK 013 FL (HMO)
• DEVOTED GIVEBACK 014 FL (HMO)
• DEVOTED GIVEBACK 015 FL (HMO)
• DEVOTED GIVEBACK 018 FL (HMO)
• DEVOTED GIVEBACK 031 FL (HMO)
• DEVOTED GIVEBACK 032 FL (HMO)
• DEVOTED GIVEBACK 035 FL (HMO)
• DEVOTED GIVEBACK 045 FL (HMO)
• DEVOTED GIVEBACK 049 FL (HMO)
• DEVOTED GIVEBACK 051 FL (HMO)
• DEVOTED PREMIUM 037 FL (HMO)
• DEVOTED PREMIUM 044 FL (HMO)

Georgia

• All Plans

Hawaii

• DEVOTED CHOICE 004 HI (PPO)
• DEVOTED CHOICE 008 HI (PPO)
• DEVOTED CHOICE GIVEBACK 005 HI (PPO)
• DEVOTED CHOICE GIVEBACK 009 HI (PPO)
• DEVOTED CHOICE PREMIUM 006 HI (PPO)
• DEVOTED CHOICE PREMIUM 010 HI (PPO)
• DEVOTED CORE 004 HI (HMO)
• DEVOTED CORE 005 HI (HMO)
• DEVOTED C-SNP PLUS 003 HI (HMO C-SNP)
• DEVOTED GIVEBACK 001 HI (HMO)
• DEVOTED GIVEBACK 002 HI (HMO)

Illinois

• All Plans

Indiana

• All Plans

Iowa

• All Plans

Kansas

• All Plans

Kentucky

• All Plans

Louisiana

• All Plans

Mississippi

• All Plans

Missouri

• All Plans

Nebraska

• All Plans

New Mexico

• All Plans

North Carolina

• DEVOTED CHOICE 001 NC (PPO)
• DEVOTED CHOICE 003 NC (PPO)
• DEVOTED CHOICE 005 NC (PPO)
• DEVOTED CHOICE 008 NC (PPO)
• DEVOTED CHOICE GIVEBACK 002 NC (PPO)
• DEVOTED CHOICE GIVEBACK 004 NC (PPO)
• DEVOTED CHOICE GIVEBACK 006 NC (PPO)
• DEVOTED CHOICE GIVEBACK 009 NC (PPO)
• DEVOTED CORE 001 NC (HMO)
• DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
• DEVOTED DUAL 009 NC (HMO D-SNP)
• DEVOTED DUAL FULL 013 NC (HMO D-SNP)
• DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
• DEVOTED GIVEBACK 002 NC (HMO)
• DEVOTED GIVEBACK 012 NC (HMO)

Ohio

• DEVOTED CHOICE 001 OH (PPO)
• DEVOTED CHOICE 003 OH (PPO)
• DEVOTED CORE 001 OH (HMO)
• DEVOTED CORE 004 OH (HMO)
• DEVOTED CORE 007 OH (HMO)
• DEVOTED CORE 015 OH (HMO)
• DEVOTED CORE 019 OH (HMO)
• DEVOTED CORE 022 OH (HMO)
• DEVOTED C-SNP PLUS 016 OH (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 017 OH (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 018 OH (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP)
• DEVOTED DUAL 011 OH (HMO D-SNP)
• DEVOTED DUAL PLUS 010 OH (HMO D-SNP)
• DEVOTED GIVEBACK 003 OH (HMO)
• DEVOTED GIVEBACK 006 OH (HMO)
• DEVOTED GIVEBACK 009 OH (HMO)
• DEVOTED PREMIUM 002 OH (HMO)

Oklahoma

• All Plans

Oregon

• DEVOTED CHOICE PREMIUM 002 OR (PPO)
• DEVOTED CORE 001 OR (HMO)
• DEVOTED CORE 003 OR (HMO)
• DEVOTED C-SNP PLUS 009 OR (HMO C-SNP)
• DEVOTED GIVEBACK 004 OR (HMO)
• DEVOTED PREMIUM 005 OR (HMO)
• DEVOTED PREMIUM 006 OR (HMO)

Pennsylvania

• DEVOTED CHOICE 007 PA (PPO)
• DEVOTED CHOICE 010 PA (PPO)
• DEVOTED CHOICE GIVEBACK 003 PA (PPO)
• DEVOTED CHOICE GIVEBACK 008 PA (PPO)
• DEVOTED CHOICE GIVEBACK 011 PA (PPO)
• DEVOTED CHOICE PREMIUM 002 PA (PPO)
• DEVOTED CORE 008 PA (HMO)
• DEVOTED CORE 010 PA (HMO)
• DEVOTED CORE 012 PA (HMO)
• DEVOTED CORE 014 PA (HMO)
• DEVOTED CORE 023 PA (HMO)
• DEVOTED C-SNP PLUS 021 PA (HMO C-SNP)
• DEVOTED C-SNP PLUS 022 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 016 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP)
• DEVOTED DUAL FULL 025 PA (HMO D-SNP)
• DEVOTED DUAL FULL 026 PA (HMO D-SNP)
• DEVOTED DUAL PLUS 005 PA (HMO D-SNP)
• DEVOTED DUAL PLUS 007 PA (HMO D-SNP)
• DEVOTED GIVEBACK 009 PA (HMO)
• DEVOTED GIVEBACK 011 PA (HMO)
• DEVOTED GIVEBACK 013 PA (HMO)
• DEVOTED GIVEBACK 015 PA (HMO)

South Carolina

• DEVOTED CHOICE 001 SC (PPO)
• DEVOTED CHOICE GIVEBACK 002 SC (PPO)
• DEVOTED CORE 001 SC (HMO)
• DEVOTED C-SNP CHOICE 004 SC (PPO C-SNP)
• DEVOTED C-SNP CHOICE PLUS 006 SC (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP)
• DEVOTED PREMIUM 003 SC (HMO)

Tennessee

• DEVOTED CHOICE 007 TN (PPO)
• DEVOTED CHOICE 010 TN (PPO)
• DEVOTED CHOICE 011 TN (PPO)
• DEVOTED CHOICE 015 TN (PPO)
• DEVOTED CHOICE GIVEBACK 002 TN (PPO)
• DEVOTED CHOICE GIVEBACK 005 TN (PPO)
• DEVOTED CHOICE GIVEBACK 006 TN (PPO)
• DEVOTED CHOICE GIVEBACK 012 TN (PPO)
• DEVOTED CORE 001 TN (HMO)
• DEVOTED CORE 004 TN (HMO)
• DEVOTED CORE 007 TN (HMO)
• DEVOTED CORE 009 TN (HMO)
• DEVOTED CORE 010 TN (HMO)
• DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 018 TN (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 019 TN (PPO C-SNP)
• DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP)
• DEVOTED GIVEBACK 002 TN (HMO)
• DEVOTED GIVEBACK 005 TN (HMO)
• DEVOTED GIVEBACK 008 TN (HMO)

Texas

• DEVOTED CHOICE GIVEBACK 001 TX (PPO)
• DEVOTED CORE 001 TX (HMO)
• DEVOTED CORE 003 TX (HMO)
• DEVOTED CORE 004 TX (HMO)
• DEVOTED CORE 007 TX (HMO)
• DEVOTED CORE 014 TX (HMO)
• DEVOTED CORE 019 TX (HMO)
• DEVOTED C-SNP 027 TX (HMO C-SNP)
• DEVOTED C-SNP 046 TX (HMO C-SNP)
• DEVOTED C-SNP PLUS 024 TX (HMO C-SNP)
• DEVOTED C-SNP PLUS 029 TX (HMO C-SNP)
• DEVOTED C-SNP PLUS 031 TX (HMO C-SNP)
• DEVOTED C-SNP PLUS 033 TX (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP)
• DEVOTED DUAL 010 TX (HMO D-SNP)
• DEVOTED DUAL 012 TX (HMO D-SNP)
• DEVOTED DUAL 015 TX (HMO D-SNP)
• DEVOTED DUAL 017 TX (HMO D-SNP)
• DEVOTED DUAL FULL 037 TX (HMO D-SNP)
• DEVOTED DUAL FULL 038 TX (HMO D-SNP)
• DEVOTED DUAL FULL 040 TX (HMO D-SNP)
• DEVOTED DUAL FULL 041 TX (HMO D-SNP)
• DEVOTED GIVEBACK 006 TX (HMO)
• DEVOTED GIVEBACK 008 TX (HMO)
• DEVOTED GIVEBACK 021 TX (HMO)
• DEVOTED GIVEBACK 048 TX (HMO)
• DEVOTED PREMIUM 002 TX (HMO)

Utah

• All Plans

Virginia

• All Plans

Washington

• All PlansAlabama:
• DEVOTED CHOICE 001 AL (PPO)
• DEVOTED CHOICE 002 AL (PPO)
• DEVOTED CHOICE GIVEBACK 005 AL (PPO)
• DEVOTED CHOICE GIVEBACK 006 AL (PPO)
• DEVOTED CORE 001 AL (HMO)
• DEVOTED C-SNP CHOICE 008 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE 010 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE PLUS 012 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE PLUS 015 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 009 AL (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP)
• DEVOTED DUAL 004 AL (HMO D-SNP)
• DEVOTED DUAL 007 AL (HMO D-SNP)
• DEVOTED DUAL CHOICE FULL 013 AL (PPO D-SNP)
• DEVOTED DUAL CHOICE FULL 014 AL (PPO D-SNP)
• DEVOTED DUAL PLUS 003 AL (HMO D-SNP)
• DEVOTED DUAL PLUS 006 AL (HMO D-SNP)
• DEVOTED GIVEBACK 002 AL (HMO)

Arizona

• DEVOTED CHOICE 001 AZ (PPO)
• DEVOTED CHOICE 002 AZ (PPO)
• DEVOTED CHOICE 003 AZ (PPO)
• DEVOTED CHOICE GIVEBACK 006 AZ (PPO)
• DEVOTED CORE 001 AZ (HMO)
• DEVOTED CORE 007 AZ (HMO)
• DEVOTED CORE 016 AZ (HMO)
• DEVOTED CORE 020 AZ (HMO)
• DEVOTED CORE 021 AZ (HMO)
• DEVOTED C-SNP 011 AZ (HMO C-SNP)
• DEVOTED C-SNP 023 AZ (HMO C-SNP)
• DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP)
• DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP)
• DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP)
• DEVOTED GIVEBACK 013 AZ (HMO)
• DEVOTED GIVEBACK 019 AZ (HMO)

Arkansas

• All Plans

Colorado

• DEVOTED CHOICE 001 CO (PPO)
• DEVOTED CHOICE 002 CO (PPO)
• DEVOTED CHOICE 005 CO (PPO)
• DEVOTED CHOICE GIVEBACK 003 CO (PPO)
• DEVOTED CORE 001 CO (HMO)
• DEVOTED CORE 004 CO (HMO)
• DEVOTED C-SNP PLUS 013 CO (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 009 CO (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 010 CO (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP)
• DEVOTED DUAL 007 CO (HMO D-SNP)
• DEVOTED DUAL FULL 012 CO (HMO D-SNP)
• DEVOTED DUAL PLUS 003 CO (HMO D-SNP)

Delaware

• All Plans

Florida

• DEVOTED CHOICE 015 FL (PPO)
• DEVOTED CHOICE GIVEBACK 008 FL (PPO)
• DEVOTED CHOICE GIVEBACK 013 FL (PPO)
• DEVOTED CORE 001 FL (HMO)
• DEVOTED CORE 002 FL (HMO)
• DEVOTED CORE 003 FL (HMO)
• DEVOTED CORE 005 FL (HMO)
• DEVOTED CORE 025 FL (HMO)
• DEVOTED CORE 027 FL (HMO)
• DEVOTED CORE 029 FL (HMO)
• DEVOTED CORE 036 FL (HMO)
• DEVOTED CORE 046 FL (HMO)
• DEVOTED CORE 050 FL (HMO)
• DEVOTED CORE 056 FL (HMO)
• DEVOTED CORE 057 FL (HMO)
• DEVOTED CORE 058 FL (HMO)
• DEVOTED CORE 059 FL (HMO)
• DEVOTED CORE 060 FL (HMO)
• DEVOTED CORE 061 FL (HMO)
• DEVOTED CORE 062 FL (HMO)
• DEVOTED CORE 063 FL (HMO)
• DEVOTED CORE 064 FL (HMO)
• DEVOTED CORE 065 FL (HMO)
• DEVOTED CORE 066 FL (HMO)
• DEVOTED C-SNP PLUS 084 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 085 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 086 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 087 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 088 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 089 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 090 FL (HMO C-SNP)
• DEVOTED C-SNP PLUS 091 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 067 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 068 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 070 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 071 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 073 FL (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 074 FL (HMO C-SNP)
• DEVOTED DUAL 019 FL (HMO D-SNP)
• DEVOTED DUAL 020 FL (HMO D-SNP)
• DEVOTED DUAL 021 FL (HMO D-SNP)
• DEVOTED DUAL 022 FL (HMO D-SNP)
• DEVOTED DUAL 023 FL (HMO D-SNP)
• DEVOTED DUAL 024 FL (HMO D-SNP)
• DEVOTED DUAL 033 FL (HMO D-SNP)
• DEVOTED DUAL 034 FL (HMO D-SNP)
• DEVOTED DUAL 039 FL (HMO D-SNP)
• DEVOTED DUAL 041 FL (HMO D-SNP)
• DEVOTED DUAL 043 FL (HMO D-SNP)
• DEVOTED DUAL FULL 077 FL (HMO D-SNP)
• DEVOTED DUAL FULL 078 FL (HMO D-SNP)
• DEVOTED DUAL FULL 079 FL (HMO D-SNP)
• DEVOTED DUAL FULL 080 FL (HMO D-SNP)
• DEVOTED DUAL FULL 081 FL (HMO D-SNP)
• DEVOTED DUAL FULL 082 FL (HMO D-SNP)
• DEVOTED DUAL FULL 083 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 042 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 052 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 053 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 054 FL (HMO D-SNP)
• DEVOTED DUAL PLUS 055 FL (HMO D-SNP)
• DEVOTED GIVEBACK 013 FL (HMO)
• DEVOTED GIVEBACK 014 FL (HMO)
• DEVOTED GIVEBACK 015 FL (HMO)
• DEVOTED GIVEBACK 018 FL (HMO)
• DEVOTED GIVEBACK 031 FL (HMO)
• DEVOTED GIVEBACK 032 FL (HMO)
• DEVOTED GIVEBACK 035 FL (HMO)
• DEVOTED GIVEBACK 045 FL (HMO)
• DEVOTED GIVEBACK 049 FL (HMO)
• DEVOTED GIVEBACK 051 FL (HMO)
• DEVOTED PREMIUM 037 FL (HMO)
• DEVOTED PREMIUM 044 FL (HMO)

Georgia

• All Plans

Hawaii

• DEVOTED CHOICE 004 HI (PPO)
• DEVOTED CHOICE 008 HI (PPO)
• DEVOTED CHOICE GIVEBACK 005 HI (PPO)
• DEVOTED CHOICE GIVEBACK 009 HI (PPO)
• DEVOTED CHOICE PREMIUM 006 HI (PPO)
• DEVOTED CHOICE PREMIUM 010 HI (PPO)
• DEVOTED CORE 004 HI (HMO)
• DEVOTED CORE 005 HI (HMO)
• DEVOTED C-SNP PLUS 003 HI (HMO C-SNP)
• DEVOTED GIVEBACK 001 HI (HMO)
• DEVOTED GIVEBACK 002 HI (HMO)

Illinois

• All Plans

Indiana

• All Plans

Iowa

• All Plans

Kansas

• All Plans

Kentucky

• All Plans

Louisiana

• All Plans

Mississippi

• All Plans

Missouri

• All Plans

Nebraska

• All Plans

New Mexico

• All Plans

North Carolina

• DEVOTED CHOICE 001 NC (PPO)
• DEVOTED CHOICE 003 NC (PPO)
• DEVOTED CHOICE 005 NC (PPO)
• DEVOTED CHOICE 008 NC (PPO)
• DEVOTED CHOICE GIVEBACK 002 NC (PPO)
• DEVOTED CHOICE GIVEBACK 004 NC (PPO)
• DEVOTED CHOICE GIVEBACK 006 NC (PPO)
• DEVOTED CHOICE GIVEBACK 009 NC (PPO)
• DEVOTED CORE 001 NC (HMO)
• DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
• DEVOTED DUAL 009 NC (HMO D-SNP)
• DEVOTED DUAL FULL 013 NC (HMO D-SNP)
• DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
• DEVOTED GIVEBACK 002 NC (HMO)
• DEVOTED GIVEBACK 012 NC (HMO)

Ohio

• DEVOTED CHOICE 001 OH (PPO)
• DEVOTED CHOICE 003 OH (PPO)
• DEVOTED CORE 001 OH (HMO)
• DEVOTED CORE 004 OH (HMO)
• DEVOTED CORE 007 OH (HMO)
• DEVOTED CORE 015 OH (HMO)
• DEVOTED CORE 019 OH (HMO)
• DEVOTED CORE 022 OH (HMO)
• DEVOTED C-SNP PLUS 016 OH (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 017 OH (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 018 OH (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP)
• DEVOTED DUAL 011 OH (HMO D-SNP)
• DEVOTED DUAL PLUS 010 OH (HMO D-SNP)
• DEVOTED GIVEBACK 003 OH (HMO)
• DEVOTED GIVEBACK 006 OH (HMO)
• DEVOTED GIVEBACK 009 OH (HMO)
• DEVOTED PREMIUM 002 OH (HMO)

Oklahoma

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Oregon

• DEVOTED CHOICE PREMIUM 002 OR (PPO)
• DEVOTED CORE 001 OR (HMO)
• DEVOTED CORE 003 OR (HMO)
• DEVOTED C-SNP PLUS 009 OR (HMO C-SNP)
• DEVOTED GIVEBACK 004 OR (HMO)
• DEVOTED PREMIUM 005 OR (HMO)
• DEVOTED PREMIUM 006 OR (HMO)

Pennsylvania

• DEVOTED CHOICE 007 PA (PPO)
• DEVOTED CHOICE 010 PA (PPO)
• DEVOTED CHOICE GIVEBACK 003 PA (PPO)
• DEVOTED CHOICE GIVEBACK 008 PA (PPO)
• DEVOTED CHOICE GIVEBACK 011 PA (PPO)
• DEVOTED CHOICE PREMIUM 002 PA (PPO)
• DEVOTED CORE 008 PA (HMO)
• DEVOTED CORE 010 PA (HMO)
• DEVOTED CORE 012 PA (HMO)
• DEVOTED CORE 014 PA (HMO)
• DEVOTED CORE 023 PA (HMO)
• DEVOTED C-SNP PLUS 021 PA (HMO C-SNP)
• DEVOTED C-SNP PLUS 022 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 016 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 020 PA (HMO C-SNP)
• DEVOTED DUAL FULL 025 PA (HMO D-SNP)
• DEVOTED DUAL FULL 026 PA (HMO D-SNP)
• DEVOTED DUAL PLUS 005 PA (HMO D-SNP)
• DEVOTED DUAL PLUS 007 PA (HMO D-SNP)
• DEVOTED GIVEBACK 009 PA (HMO)
• DEVOTED GIVEBACK 011 PA (HMO)
• DEVOTED GIVEBACK 013 PA (HMO)
• DEVOTED GIVEBACK 015 PA (HMO)

South Carolina

• DEVOTED CHOICE 001 SC (PPO)
• DEVOTED CHOICE GIVEBACK 002 SC (PPO)
• DEVOTED CORE 001 SC (HMO)
• DEVOTED C-SNP CHOICE 004 SC (PPO C-SNP)
• DEVOTED C-SNP CHOICE PLUS 006 SC (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP)
• DEVOTED PREMIUM 003 SC (HMO)

Tennessee

• DEVOTED CHOICE 007 TN (PPO)
• DEVOTED CHOICE 010 TN (PPO)
• DEVOTED CHOICE 011 TN (PPO)
• DEVOTED CHOICE 015 TN (PPO)
• DEVOTED CHOICE GIVEBACK 002 TN (PPO)
• DEVOTED CHOICE GIVEBACK 005 TN (PPO)
• DEVOTED CHOICE GIVEBACK 006 TN (PPO)
• DEVOTED CHOICE GIVEBACK 012 TN (PPO)
• DEVOTED CORE 001 TN (HMO)
• DEVOTED CORE 004 TN (HMO)
• DEVOTED CORE 007 TN (HMO)
• DEVOTED CORE 009 TN (HMO)
• DEVOTED CORE 010 TN (HMO)
• DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 018 TN (PPO C-SNP)
• DEVOTED C-SNP CHOICE PREMIUM 019 TN (PPO C-SNP)
• DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP)
• DEVOTED GIVEBACK 002 TN (HMO)
• DEVOTED GIVEBACK 005 TN (HMO)
• DEVOTED GIVEBACK 008 TN (HMO)

Texas

• DEVOTED CHOICE GIVEBACK 001 TX (PPO)
• DEVOTED CORE 001 TX (HMO)
• DEVOTED CORE 003 TX (HMO)
• DEVOTED CORE 004 TX (HMO)
• DEVOTED CORE 007 TX (HMO)
• DEVOTED CORE 014 TX (HMO)
• DEVOTED CORE 019 TX (HMO)
• DEVOTED C-SNP 027 TX (HMO C-SNP)
• DEVOTED C-SNP 046 TX (HMO C-SNP)
• DEVOTED C-SNP PLUS 024 TX (HMO C-SNP)
• DEVOTED C-SNP PLUS 029 TX (HMO C-SNP)
• DEVOTED C-SNP PLUS 031 TX (HMO C-SNP)
• DEVOTED C-SNP PLUS 033 TX (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP)
• DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP)
• DEVOTED DUAL 010 TX (HMO D-SNP)
• DEVOTED DUAL 012 TX (HMO D-SNP)
• DEVOTED DUAL 015 TX (HMO D-SNP)
• DEVOTED DUAL 017 TX (HMO D-SNP)
• DEVOTED DUAL FULL 037 TX (HMO D-SNP)
• DEVOTED DUAL FULL 038 TX (HMO D-SNP)
• DEVOTED DUAL FULL 040 TX (HMO D-SNP)
• DEVOTED DUAL FULL 041 TX (HMO D-SNP)
• DEVOTED GIVEBACK 006 TX (HMO)
• DEVOTED GIVEBACK 008 TX (HMO)
• DEVOTED GIVEBACK 021 TX (HMO)
• DEVOTED GIVEBACK 048 TX (HMO)
• DEVOTED PREMIUM 002 TX (HMO)

Utah

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Virginia

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Washington

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