| Plan Name | Enrollment Code(s) | PDF Version | Accessible Version |
|---|
| Advantage Health Plan, Inc. |
6Y |
PDF |
Accessible |
| Aetna Health Inc. |
JN |
PDF |
Accessible |
| Aetna Health Inc. |
2U, 2X, 6J, 7D, 8J, JC, P3, RD, UB, WQ |
PDF |
Accessible |
| Alliance Health Benefit Plan |
1R |
PDF |
Accessible |
| Altius Health Plans |
9K |
PDF |
Accessible |
| AmeriHealth HMO, Inc. |
FK |
PDF |
Accessible |
| APWU Health Plan |
47 |
PDF |
Accessible |
| Arnett HMO Health Plan |
G2 |
PDF |
Accessible |
| Association Benefit Plan |
42 |
PDF |
Accessible |
| Avera Health Plan |
AV |
PDF |
Accessible |
| AultCare HMO |
3A |
PDF |
Accessible |
| Av-Med Health Plan |
EM |
PDF |
Accessible |
| Av-Med Health Plan (South Florida) |
ML |
PDF |
Accessible |
| Blue Care Network |
G7, K5, KF, KN, KR, LN, LX |
PDF |
Accessible |
| Blue Chip, Coordinated Health Partners, |
DA |
PDF |
Accessible |
| Blue Choice |
MK |
PDF |
Accessible |
| BlueCHOICE |
9G |
PDF |
Accessible |
| Blue Cross and Blue Shield Service Benefit Plan |
10, 11 |
PDF |
Accessible |
| Blue Cross- HMO |
M5 |
PDF |
Accessible |
| Blue HMO (formerly Health Maintenance Plan-HMP) |
R5 |
PDF |
Accessible |
| Blue Shield of California Access+ |
SJ |
PDF |
Accessible |
| Capital District Physicians' Health Plan, Inc. |
PW, QB, SG |
PDF |
Accessible |
| Capital Health Plan |
EA |
PDF |
Accessible |
| CareFirst BlueChoice |
2G |
PDF |
Accessible |
| CIGNA HealthCare of California |
9T |
PDF |
Accessible |
| Cimarron Health Plan |
PX |
PDF |
Accessible |
| ConnectiCare, Inc. |
TE |
PDF |
Accessible |
| Coventry Health Care of Iowa, Inc. |
SV |
PDF |
Accessible |
| Coventry Health Care of Kansas (Kansas City) |
HA |
PDF |
Accessible |
| Coventry Health Care of Kansas, Inc. |
7W |
PDF |
Accessible |
| Coventry Health Care of Louisiana |
BJ, JA |
PDF |
Accessible |
| Dean Health Plan |
WD |
PDF |
Accessible |
| Fallon Community Health Plan |
JV |
PDF |
Accessible |
| FIRSTCARE |
6U, CK |
PDF |
Accessible |
| Foreign Service Benefit Plan |
40 |
PDF |
Accessible |
| Foundation Health, A Florida Health Plan |
5E |
PDF |
Accessible |
| GHI HMO Select, Inc. |
6V, X4 |
PDF |
Accessible |
| Government Employees Hospital Association (GEHA) Benefit Plan |
31 |
PDF |
Accessible |
| Grand Valley Health Plan |
RL |
PDF |
Accessible |
| Group Health Cooperative of Eau Claire |
WT |
PDF |
Accessible |
| Group Health Cooperative of Puget Sound |
54, VR |
PDF |
Accessible |
| Group Health Cooperative of South Central Wisconsin |
WJ |
PDF |
Accessible |
| Group Health Incorporated |
80 |
PDF |
Accessible |
| Group Health Plan, Inc. |
MM |
PDF |
Accessiblel |
| Hawaii Medical Service Association Plan |
87 |
PDF |
Accessible |
| Health Alliance HMO |
FX |
PDF |
Accessible |
| Health Alliance Plan |
52 |
PDF |
Accessible |
| Health Insurance Plan of Greater New York (HIP/HMO) |
51 |
PDF |
Accessible |
| Health Net |
LB |
PDF |
Accessible |
| Health Net of Arizona (formerly Intergroup of Arizona, Inc.) |
A7 |
PDF |
Accessible |
| Health Net of Pennsylvania (formerly PHS Health Plans, QualMed Plans for Health, and Greater Atlantic Health Service) |
27, 2K |
PDF |
Accessible |
| Health Plan of Nevada, Inc. |
NM |
PDF |
Accessible |
| HealthAmerica Pennsylvania |
26, SW |
PDF |
Accessible |
| HealthGuard |
NQ |
PDF |
Accessible |
| HealthPartners Classic |
53 |
PDF |
Accessible |
| HealthPartners Primary Clinic Plan |
HQ |
PDF |
Accessible |
| Health Plan of the Upper Ohio Valley, Inc., The |
U4 |
PDF |
Accessible |
| Healthplan Southeast |
RK |
PDF |
Accessible |
| HealthPlus of Michigan |
X5 |
PDF |
Accessible |
| Healthspring |
6K |
PDF |
Accessible |
| Heart of America HMO Health Plan |
RU |
PDF |
Accessible |
| HMO Blue |
AH |
PDF |
Accessible |
| HMO Blue Texas |
YM, YX |
PDF |
Accessible |
| HMO-CNY, Inc. |
EB |
PDF |
Accessible |
| HMO Health Ohio |
L4 |
PDF |
Accessible |
| Humana Medical Plan, Inc. |
EE |
PDF |
Accessible |
| Humana Health Plan, Inc. |
MS |
PDF |
Accessible |
| Humana Health Plan, Inc. |
D2 |
PDF |
Accessible |
| Humana Health Plan Inc. - Chicago |
75 |
PDF |
Accessible |
| Humana Health Plans of Puerto Rico |
ZJ |
PDF |
Accessible |
| Humana Health Plan of Texas |
UR |
PDF |
Accessible |
| Independent Health Association |
QA |
PDF |
Accessible |
| JMH Health Plan |
J8 |
PDF |
Accessible |
| John Deere Health Plan, Inc. |
YH |
PDF |
Accessible |
| Kaiser Foundation Health Plan Inc., Hawaii Region |
63 |
PDF |
Accessible |
| Kaiser Foundation Health Plan of Colorado |
65 |
PDF |
Accessible |
| Kaiser Foundation Health Plan of Georgia, Inc. |
F8 |
PDF |
Accessible |
| Kaiser Foundation Health Plan of Ohio |
64 |
PDF |
Accessible |
| Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. |
E3 |
PDF |
Accessible |
| Kaiser Foundation Health Plan of the Northwest |
57 |
PDF |
Accessible |
| Kaiser Foundation Health Plan, Inc., Northern California Region |
59 |
PDF |
Accessible |
| Kaiser Foundation Health Plan, Inc., Southern California Region |
62 |
PDF |
Accessible |
| Keystone Health Plan Central |
S4 |
PDF |
Accessible |
| Keystone Health Plan East |
ED |
PDF |
Accessible |
| KPS Health Plans |
VT |
PDF |
Accessible |
| Lovelace Health Plan |
Q1 |
PDF |
Accessible |
| M*Plan, Inc. |
IN |
PDF |
Accessible |
| Mail Handlers Benefit Plan |
45 |
PDF |
Accessible |
| M.D. IPA: The Quality Care Health Plan |
JP |
PDF |
Accessible |
| M-Care |
EG |
PDF |
Accessible |
| Mercy Health Plans/Premier Health Plans |
7M, HM |
PDF |
Accessible |
| Michigan Health Maintenance Organization Plans,Inc |
KA |
PDF |
Accessible |
| MVP Health Plan |
GA, M9, MX, VW |
PDF |
Accessible |
| NALC Health Benefit Plan |
32 |
PDF |
Accessible |
| National Rural Carriers Association |
38 |
PDF |
Accessible |
| New West Health Plan |
NV |
PDF |
Accessible |
| Optima Health Plan |
9R |
PDF |
Accessible |
| OSF HealthPlans, Inc. |
9F |
PDF |
Accessible |
| PacifiCare Asia Pacific |
JK |
PDF |
Accessible |
| PacifiCare of Colorado, Inc. |
D6 |
PDF |
Accessible |
| PacifiCare Health Plans |
2N, 7Z, A3, CY, GF, K9, WB |
PDF |
Accessible |
| Panama Canal Area Benefit Plan |
43 |
PDF |
Accessible |
| Paramount Health Care |
U2 |
PDF |
Accessible |
| PersonalCare's HMO Health Plan |
GE |
PDF |
Accessible |
| Physicians Health Plan of Northern Indiana |
DQ |
PDF |
Accessible |
| Piedmont Community Healthcare (Virginia) |
2C |
PDF |
Accessible |
| Postmasters Benefit Plan |
36 |
PDF |
Accessible |
| Preferred Care |
GV |
PDF |
Accessible |
| Preferred Plus of Kansas |
VA |
PDF |
Accessible |
| Presbyterian Health Plan |
P2 |
PDF |
Accessible |
| PrimeHealth of Alabama, Inc. |
AA |
PDF |
Accessible |
| SAMBA Health Benefit Plan |
44 |
PDF |
Accessible |
| Sioux Valley Health Plan |
AU |
PDF |
Accessible |
| SummaCare Health Plan |
5W |
PDF |
Accessible |
| SuperMed HMO |
5M |
PDF |
Accessible |
| The Oath - A Health Plan for Alabama, Inc. |
DF |
PDF |
Accessible |
| Total Health Care |
N2 |
PDF |
Accessible |
| Total Health Choice |
4A |
PDF |
Accessible |
| Triple - S, Inc. |
89 |
PDF |
Accessible |
| UHP Healthcare |
C4 |
PDF |
Accessible |
| Unicare Health Plan (formerly Rush Prudential) |
17 |
PDF |
Accessible |
| Union Health Service |
76 |
PDF |
Accessible |
| United Healthcare of Ohio, Inc. |
3U |
PDF |
Accessible |
| Univera Healthcare |
KQ, Q8 |
PDF |
Accessible |
| Universal Care |
6Q |
PDF |
Accessible |
| UPMC Health Plan |
8W |
PDF |
Accessible |
| U.S. Secret Service Employees Health Assoc. |
Y7 |
PDF |
Accessible |
| Vantage Health Plan |
AQ, MV |
PDF |
Accessible |
| Vista Healthplan |
3N |
PDF |
Accessible |
| Vytra Health Plans |
J6 |
PDF |
Accessible |
| Wellness Plan, The |
K3 |
PDF |
Accessible |
| WinHealth Partners |
PV |
PDF |
Accessible |
U.S. Office of Personnel Management 1900 E Street NW, Washington, DC 20415 | (202) 606-1800 | TTY (202) 606-2532