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StatePlan TypeIssuer and Plan NameSupplementedCategoriesPediatric dentalPediatric visionSupplementary PlanTypeFEDVIPFEDVIPPediatric dentalPediatric visionPediatric dentalPediatric visionHabilitation services(Federal Definition)FEDVIPFEDVIPAlabamaSmall Group MarketBlue Cross and Blue Shield of Alabama 320 PlanAlaskaSmall Group MarketPremera Blue Cross Blue Shield of Alaska Heritage Select EnvoyArizonaState Employee PlanThe State of Arizona EPO EmployeeHealth PlanArkansasSmall Group MarketHMO Partners, Inc. - Small Group Gold1000-1Pediatric dentalCHIPCaliforniaSmall Group MarketKaiser Foundation Health Plan Inc. - SmallGroup HMO 30Pediatric dentalPediatric visionCHIPFEDVIPColoradoState Employee PlanColorado State LG A230 State EmployeeHealth PlanPediatric dentalCHIPConnecticutSmall Group MarketConnectiCare Insurance Company, Inc. Connecticare Flex POS planNoneNoneDelawareSmall Group MarketHighmark BCBSD Inc. - Small GroupShared Cost EPO 2000/100 PlanNoneNoneDistrict of ColumbiaSmall Group MarketGHMSI - Blue Preferred PPO 1,000 100%/80%NoneNoneFloridaSmall Group MarketBlue Cross and Blue Shield of Florida BlueOptions 5462Pediatric dentalPediatric visionHabilitation services(Federal Definition)FEDVIPFEDVIPGeorgiaSmall Group MarketHumana Employers Health Plan ofGeorgia, Inc. - Copay Option 22NoneNoneHawaii Medical Service Association Preferred Provider Plan 2010Pediatric dentalPediatric visionHabilitation services(Federal Definition)CHIPFEDVIPHawaiiSmall Group MarketFEDVIPFEDVIP
IdahoSmall Group MarketBlue Cross of Idaho Health Service, Inc. Preferred Blue PPO Small GroupSupplementedCategoriesPediatric dentalPediatric visionIllinoisSmall Group MarketBlue Cross Blue Shield of Illinois - BluePPO Gold 011Pediatric dentalPediatric visionCHIPFEDVIPIndianaSmall Group MarketAnthem Ins Companies Inc - Blue 6.0 BlueAccess PPO Option 14, Rx GPediatric dentalPediatric visionFEDVIPFEDVIPIowaSmall Group MarketWellmark Inc. - CompleteBlue 2000Pediatric dentalFEDVIPKansasSmall Group MarketBlue Cross and Blue Shield of Kansas, Inc. Blue Choice Comprehensive MajorMedicalPediatric dentalPediatric visionHabilitation services(Federal Definition)CHIPCHIPKentuckySmall Group MarketUnitedHealthcare of Kentucky, Ltd. Choice PlusNoneNoneLouisianaSmall Group MarketLouisiana Health Service & IndemnityCompany - GroupCare Copay 80/60 1000MaineSmall Group MarketAnthem Health Plans of Maine (AnthemBCBS) - Blue Choice, 30.00, 2,500 DedMarylandSmall Group MarketMassachusettsSmall Group MarketMichiganSmall Group MarketMinnesotaSmall Group MarketStatePlan TypeIssuer and Plan NameCareFirst BlueChoice, Inc. - BlueChoiceHMO HSA-HRA 1,500Blue Cross and Blue Shield ofMassachusetts HMO Blue, Inc. - HMOBlue New England 2000 DeductiblePediatric dentalPediatric visionHabilitation services(Federal Definition)Pediatric dentalPediatric visionSupplementary nePediatric dentalPediatric visionCHIPFEDVIPPriorityHealth - PriorityHMOPediatric dentalPediatric visionCHIPFEDVIPHealthPartners, Inc. - HLPT-129123512Pediatric dentalFEDVIP
StatePlan TypeIssuer and Plan NameSupplementedCategoriesPediatric dentalPediatric visionHabilitation services(Federal Definition)Supplementary PlanTypeMississippiSmall Group MarketBlue Cross Blue Shield of Mississippi Network BlueCHIPCHIPMissouriSmall Group MarketHealthy Alliance Life Co (Anthem BCBS) PPO On ExchangePediatric dentalFEDVIPMontanaSmall Group MarketBlue Cross and Blue Shield of Montana Blue Preferred Gold PPO 007Pediatric dentalFEDVIPNebraskaSmall Group MarketBlue Cross and Blue Shield of Nebraska Blue Pride Plus Option 102 GoldNoneNoneNevadaSmall Group MarketHealth Plan of Nevada, Inc. - HPNSolutions HMO Platinum 15/0/90%NoneNoneNew HampshireSmall Group MarketAnthem - Matthew Thornton BluePediatric dentalFEDVIPNew JerseySmall Group MarketHorizon Healthcare Services, Inc. Advantage EPO Silver 100/50Pediatric dentalCHIPNew MexicoState Non-MedicaidHMOPresbyterian Health Plan Inc. - IndividualSilver C HMOPediatric dentalPediatric visionHabilitation services(Federal Definition)CHIPCHIPNew YorkSmall Group MarketOxford Health Insurance, Inc. - OxfordEPONoneNoneNorth CarolinaSmall Group MarketBlue Cross and Blue Shield of NorthCarolina - Blue Options PPOPediatric dentalPediatric visionFEDVIPFEDVIPNorth DakotaSmall Group MarketBlue Cross Blue Shield of North Dakota BlueCare Gold 90 500NoneNone
StatePlan TypeIssuer and Plan NameOhioSmall Group MarketCommunity Insurance Company (AnthemBCBS) - Blue Access (PPO) - Standard OptD55OklahomaSmall Group MarketOregonSmall Group MarketPennsylvaniaSmall Group MarketRhode IslandSmall Group MarketBlue Cross Blue Shield of Oklahoma - BlueOptions Gold 002PacificSource Health Plans - PreferredCodeduct Value 3000 35/70% 0812Tiered Value Rx 10/50/75 0812Keystone Health Plan East, Inc. - GoldPremier HMOBlue Cross Blue Shield of Rhode Island VantageBlue 100/60 1500/3000 RX3/12/35/60/100 WOPDSupplementedCategoriesPediatric dentalPediatric visionHabilitation andrehabilitation services(State Definition)Supplementary PlanTypeFEDVIPFEDVIPNoneNonePediatric dentalPediatric visionOHP PlusFEDVIPNoneNonePediatric dentalFEDVIPPediatric visionPediatric dentalHabilitation services(Federal Definition)Pediatric dentalPediatric visionSouth CarolinaSmall Group MarketBlue Cross and Blue Shield of SouthCarolina - Business Blue CompleteFEDVIPFEDVIPSouth DakotaSmall Group MarketWellmark of South Dakota - Blue SelectPrimary PCP/NonPCP Copay PlanTennesseeSmall Group MarketBlueCross BlueShield of Tennessee - SGGold 13SNoneNoneTexasSmall Group MarketBlue Cross Blue Shield of Texas - BlueChoice PPO RSH3Pediatric dentalPediatric visionFEDVIPFEDVIPUtahState Employee PlanPublic Employees Health Program (PEHP)Utah Basic Plus PlanHabilitation services(State Definition)NoneVermontSmall Group MarketThe Vermont Health Plan, LLC - SilverCDHP PlanNoneNoneFEDVIPFEDVIP
StatePlan TypeIssuer and Plan NameSupplementedCategoriesSupplementary PlanTypeVirginiaSmall Group MarketAnthem Health Plans of VA (AnthemBCBS) - Premier DirectAccess PPOPediatric dentalCHIPWashingtonSmall Group MarketRegence BlueShield - Regence Direct Gold NoneNoneWest VirginiaSmall Group MarketHighmark Blue Cross Blue Shield WestVirginia - Gold Shared Cost PPO 1000NoneNoneWisconsinSmall Group MarketUnitedHealthcare Insurance Company Choice PlusPediatric dentalPediatric visionHabilitation services(State Definition)FEDVIPFEDVIPWyomingSmall Group MarketBlue Cross Blue Shield of Wyoming BlueSelect Silver for Employer GroupsNoneNone
Blue Cross and Blue Shield of Florida - BlueOptions 5462 Pediatric dental Pediatric vision Habilitation services (Federal Definition) FEDVIP FEDVIP Georgia Small Group Market Humana Employers Health Plan of Georgia, Inc. - Copay Option 22 None None Hawaii . Pediatric dental CHIP New Mexico State Non-Medicaid HMO Presbyterian Health Plan Inc .
