Medicare Advantage
Devoted Health Medicare Advantage plans for 2027
Part of Devoted Health, Inc.
| Plan summary | |
|---|---|
| Plans in 2027 | 740 |
| Special needs plans (SNPs) | 333 |
| States served | 34 |
| Star rating range | 3.0 to 4.5 |
| $0 premium plans | 713 |
| Premium range (monthly) | $0 to $69 |
| HMO plans | 409 |
| PPO plans | 331 |
| States | AL, AR, AZ, CO, CT, DE, FL, GA, HI, IA, IL, IN, KS, KY, LA, MI, MO, MS, NC, NE, NH, NJ, NM, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA |
Plan year 2027 · Source: CMS · Checked October 29, 2026
What Devoted Health offers
Devoted Health is part of Devoted Health, Inc., and for 2027 it filed 740 Medicare Advantage plans with Medicare, which makes it one of the largest sellers in the program. Its plans are sold in 34 states, and the exact plans on offer change from one county to the next.
The company sells these kinds of plans:
- HMO plans (409)
- PPO plans (331)
The company sells just two kinds of plans, HMO plans and PPO plans, which keeps its lineup simpler than most large sellers. With an HMO you choose a main doctor and most care stays in the network, while a PPO often lets you see doctors outside the network at a higher cost.
It also sells 333 special needs plans, which are plans built for people in a set group, such as people who have both Medicare and Medicaid or people living with a long-term health condition that needs steady care.
What its plans cost
Of the 740 plans, 713 charge no monthly premium at all, which is 96 out of every 100 plans the company sells, although you still pay your Part B premium each month, just as you would with any Medicare Advantage plan.
A $0 premium does not mean $0 care, because each plan has its own copays and its own yearly limit on what you pay out of pocket for covered care. Those numbers change from plan to plan, and the plan pages in this section show the exact numbers for each plan, straight from Medicare's own files.
Star ratings
Medicare rates each contract from 1 to 5 stars, and Devoted Health contracts run from 3.0 to 4.5 stars for 2027, because the rating belongs to the contract and not to the brand as a whole. Two plans with the same company name can sit under contracts with very different ratings, so check the star rating on the plan page and not just the company name.
How to shop this company
Start with your county, because plans are sold by county. The plan a friend has in one state may not exist in yours, or may cost more where you live. Then check three things: your doctors are in the network, your drugs are on the drug list, and the yearly cost limit fits your budget.
Some care needs approval before the plan will pay for it, so read how approval for home health works in a Medicare Advantage plan before you count on care at home. If you ever need hospice care, Medicare covers hospice under Part A in every plan — see what Medicare hospice covers, in the hospice guide.
This page is a guide, not a sales tool, and Care and Living Guide does not sell or enroll anyone in a plan. When you are ready to sign up, use Medicare.gov, call 1-800-MEDICARE, or talk with a licensed insurance agent.
More detail about this company
Devoted Health sells Medicare Advantage plans under its parent, Devoted Health, Inc., and Medicare's 2027 file lists 740 of its plans sold in Alabama, Arkansas, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia and Washington. 728 of those plans include prescription drug coverage, and 333 are special needs plans. Medicare's file does not give the year this company first sold Medicare plans, so this page states no start year rather than guessing one.
For help with a plan from this company, start with Medicare.gov: its Plan Finder lists this company's plans for your ZIP code, and each plan's page there links to the plan's own Summary of Benefits and to the company's official Medicare pages, which carry its member phone number and hours. You can also call 1-800-MEDICARE at any hour. This page does not copy a phone number from an ad or a sales page.
Who this company may fit: many of its plans charge no monthly premium, so it may fit people who watch the monthly cost first; it sells special needs plans, so it may fit people who qualify for one of those plans.
You can join most Medicare Advantage plans for 2027 during the yearly enrollment period, October 15 to December 7, 2026. If you already have a Medicare Advantage plan, you can switch plans or go back to Original Medicare from January 1 to March 31. A move or another big life change can open a special window of its own. To join, use Medicare.gov, call 1-800-MEDICARE, or talk with a licensed insurance agent. Care and Living Guide does not sell or enroll anyone in a plan.
Detail sources for this section, checked October 30, 2026: Medicare.gov (Plan Finder and enrollment guidance) and SSA.gov (enrollment periods). Those sources add context only. Every figure on this page still comes from CMS.
Care and Living Guide is not connected with or endorsed by the U.S. government or the federal Medicare program. For official information visit Medicare.gov or call 1-800-MEDICARE.
Plans
| Plan | Plan type | Monthly premium | Out-of-pocket max (in network) | Drug deductible | Dental allowance | Vision allowance | Hearing allowance |
|---|---|---|---|---|---|---|---|
| DEVOTED C-SNP 011 AZ (HMO C-SNP) | HMO C-SNP | $0 | $6,750 | $700 | $1,500 | $150 | |
| DEVOTED C-SNP 023 AZ (HMO C-SNP) | HMO C-SNP | $0 | $3,350 | $700 | $3,500 | $300 | |
| DEVOTED C-SNP 027 TX (HMO C-SNP) | HMO C-SNP | $0 | $3,750 | $700 | $3,500 | $400 | |
| DEVOTED C-SNP 046 TX (HMO C-SNP) | HMO C-SNP | $0 | $4,450 | $461 | $3,000 | $400 | |
| DEVOTED C-SNP CHOICE 004 SC (PPO C-SNP) | PPO C-SNP | $0 | $7,350 | $700 | $3,500 | $400 | |
| DEVOTED C-SNP CHOICE 006 AR (PPO C-SNP) | PPO C-SNP | $0 | $6,000 | $700 | $3,500 | $350 | |
| DEVOTED C-SNP CHOICE 006 MS (PPO C-SNP) | PPO C-SNP | $0 | $5,700 | $700 | $3,500 | $350 | |
| DEVOTED C-SNP CHOICE 008 AL (PPO C-SNP) | PPO C-SNP | $0 | $6,500 | $700 | $3,500 | $350 | |
| DEVOTED C-SNP CHOICE 010 AL (PPO C-SNP) | PPO C-SNP | $0 | $6,500 | $700 | $3,500 | $350 | |
| DEVOTED C-SNP CHOICE ENHANCED 003 KS (PPO C-SNP) | PPO C-SNP | $0 | $4,400 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 003 UT (PPO C-SNP) | PPO C-SNP | $0 | $6,350 | $461 | $2,000 | $200 | |
| DEVOTED C-SNP CHOICE ENHANCED 004 CT (PPO C-SNP) | PPO C-SNP | $0 | $6,750 | $650 | $1,000 | $200 | |
| DEVOTED C-SNP CHOICE ENHANCED 004 NH (PPO C-SNP) | PPO C-SNP | $0 | $7,300 | $650 | $500 | $200 | |
| DEVOTED C-SNP CHOICE ENHANCED 004 NJ (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,000 | $200 | |
| DEVOTED C-SNP CHOICE ENHANCED 005 KY (PPO C-SNP) | PPO C-SNP | $0 | $6,300 | $461 | $1,500 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 005 SC (PPO C-SNP) | PPO C-SNP | $0 | $7,200 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 005 WA (PPO C-SNP) | PPO C-SNP | $0 | $7,550 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 006 KY (PPO C-SNP) | PPO C-SNP | $0 | $6,550 | $461 | $1,500 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 007 AR (PPO C-SNP) | PPO C-SNP | $0 | $6,200 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 007 KS (PPO C-SNP) | PPO C-SNP | $0 | $4,400 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 007 MS (PPO C-SNP) | PPO C-SNP | $0 | $5,900 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 009 AL (PPO C-SNP) | PPO C-SNP | $0 | $6,700 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 009 NE (PPO C-SNP) | PPO C-SNP | $0 | $5,200 | $461 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE ENHANCED 009 OK (PPO C-SNP) | PPO C-SNP | $0 | $6,200 | $461 | $1,500 | $400 | |
| DEVOTED C-SNP CHOICE ENHANCED 010 MI (PPO C-SNP) | PPO C-SNP | $0 | $6,950 | $650 | $2,000 | $200 | |
| DEVOTED C-SNP CHOICE ENHANCED 010 OK (PPO C-SNP) | PPO C-SNP | $0 | $5,850 | $461 | $1,500 | $400 | |
| DEVOTED C-SNP CHOICE ENHANCED 011 AL (PPO C-SNP) | PPO C-SNP | $0 | $6,500 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 011 IL (PPO C-SNP) | PPO C-SNP | $0 | $5,500 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 012 LA (PPO C-SNP) | PPO C-SNP | $0 | $6,200 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 012 MI (PPO C-SNP) | PPO C-SNP | $0 | $6,950 | $650 | $2,000 | $200 | |
| DEVOTED C-SNP CHOICE ENHANCED 013 AL (PPO C-SNP) | PPO C-SNP | $0 | $6,100 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP CHOICE ENHANCED 013 CT (PPO C-SNP) | PPO C-SNP | $0 | $6,750 | $650 | $1,000 | $200 | |
| DEVOTED C-SNP CHOICE ENHANCED 013 IL (PPO C-SNP) | PPO C-SNP | $0 | $4,650 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 013 LA (PPO C-SNP) | PPO C-SNP | $0 | $5,200 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 014 AL (PPO C-SNP) | PPO C-SNP | $0 | $6,100 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP CHOICE ENHANCED 014 IL (PPO C-SNP) | PPO C-SNP | $0 | $4,700 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 014 IN (PPO C-SNP) | PPO C-SNP | $0 | $5,100 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 015 GA (PPO C-SNP) | PPO C-SNP | $0 | $7,900 | $465 | $1,500 | $250 | |
| DEVOTED C-SNP CHOICE ENHANCED 015 IN (PPO C-SNP) | PPO C-SNP | $0 | $5,300 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 016 IN (PPO C-SNP) | PPO C-SNP | $0 | $6,200 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 016 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,000 | $250 | |
| DEVOTED C-SNP CHOICE ENHANCED 017 GA (PPO C-SNP) | PPO C-SNP | $0 | $8,950 | $465 | $1,500 | $250 | |
| DEVOTED C-SNP CHOICE ENHANCED 017 IN (PPO C-SNP) | PPO C-SNP | $0 | $5,900 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 017 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,000 | $250 | |
| DEVOTED C-SNP CHOICE ENHANCED 018 GA (PPO C-SNP) | PPO C-SNP | $0 | $8,950 | $465 | $1,500 | $250 | |
| DEVOTED C-SNP CHOICE ENHANCED 018 LA (PPO C-SNP) | PPO C-SNP | $0 | $6,550 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP CHOICE ENHANCED 018 TN (PPO C-SNP) | PPO C-SNP | $0 | $6,900 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE ENHANCED 019 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,000 | $250 | |
| DEVOTED C-SNP CHOICE ENHANCED 020 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,000 | $250 | |
| DEVOTED C-SNP CHOICE ENHANCED 027 TN (PPO C-SNP) | PPO C-SNP | $0 | $6,200 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP CHOICE ENHANCED 028 TN (PPO C-SNP) | PPO C-SNP | $0 | $6,200 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP CHOICE ENHANCED 029 TN (PPO C-SNP) | PPO C-SNP | $0 | $6,200 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP CHOICE ENHANCED 030 TN (PPO C-SNP) | PPO C-SNP | $0 | $6,050 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP CHOICE ENHANCED 037 TN (PPO C-SNP) | PPO C-SNP | $0 | $6,150 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 004 DE (PPO C-SNP) | PPO C-SNP | $0 | $8,450 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 005 CT (PPO C-SNP) | PPO C-SNP | $0 | $7,400 | $700 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 005 NH (PPO C-SNP) | PPO C-SNP | $0 | $7,650 | $700 | $2,000 | $200 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 005 NJ (PPO C-SNP) | PPO C-SNP | $0 | $9,650 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 007 MI (PPO C-SNP) | PPO C-SNP | $0 | $8,050 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 008 KY (PPO C-SNP) | PPO C-SNP | $0 | $7,850 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 009 KY (PPO C-SNP) | PPO C-SNP | $0 | $7,850 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 009 MI (PPO C-SNP) | PPO C-SNP | $0 | $8,050 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 010 NE (PPO C-SNP) | PPO C-SNP | $0 | $7,250 | $700 | $3,250 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 011 AR (PPO C-SNP) | PPO C-SNP | $0 | $7,600 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 011 MS (PPO C-SNP) | PPO C-SNP | $0 | $7,500 | $700 | $2,500 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 011 OK (PPO C-SNP) | PPO C-SNP | $0 | $7,650 | $700 | $2,000 | $350 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 011 UT (PPO C-SNP) | PPO C-SNP | $0 | $8,000 | $700 | $3,750 | $350 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 012 OK (PPO C-SNP) | PPO C-SNP | $0 | $7,750 | $700 | $4,000 | $350 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 014 CT (PPO C-SNP) | PPO C-SNP | $0 | $7,400 | $700 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 015 IL (PPO C-SNP) | PPO C-SNP | $0 | $7,300 | $700 | $3,750 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 016 IL (PPO C-SNP) | PPO C-SNP | $0 | $6,850 | $700 | $3,250 | $250 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 017 AL (PPO C-SNP) | PPO C-SNP | $0 | $7,250 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 017 IL (PPO C-SNP) | PPO C-SNP | $0 | $7,000 | $700 | $3,500 | $250 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 018 AL (PPO C-SNP) | PPO C-SNP | $0 | $7,700 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 019 GA (PPO C-SNP) | PPO C-SNP | $0 | $8,550 | $700 | $2,500 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 019 IN (PPO C-SNP) | PPO C-SNP | $0 | $7,100 | $700 | $2,250 | $350 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 019 LA (PPO C-SNP) | PPO C-SNP | $0 | $7,000 | $700 | $4,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 020 GA (PPO C-SNP) | PPO C-SNP | $0 | $8,900 | $700 | $2,500 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 020 IN (PPO C-SNP) | PPO C-SNP | $0 | $7,350 | $700 | $2,250 | $350 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 020 KS (PPO C-SNP) | PPO C-SNP | $0 | $7,000 | $700 | $3,750 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 020 LA (PPO C-SNP) | PPO C-SNP | $0 | $6,600 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 021 GA (PPO C-SNP) | PPO C-SNP | $0 | $8,900 | $700 | $2,500 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 021 IN (PPO C-SNP) | PPO C-SNP | $0 | $7,500 | $700 | $4,250 | $350 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 021 KS (PPO C-SNP) | PPO C-SNP | $0 | $7,250 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 021 LA (PPO C-SNP) | PPO C-SNP | $0 | $7,050 | $700 | $2,200 | $225 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 022 IN (PPO C-SNP) | PPO C-SNP | $0 | $7,300 | $700 | $4,250 | $350 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 022 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,750 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 023 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,750 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 025 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,650 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 026 MO (PPO C-SNP) | PPO C-SNP | $0 | $5,700 | $700 | $4,000 | $350 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 026 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,750 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 032 TN (PPO C-SNP) | PPO C-SNP | $0 | $6,800 | $700 | $2,250 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 034 TN (PPO C-SNP) | PPO C-SNP | $0 | $7,400 | $700 | $2,500 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 035 TN (PPO C-SNP) | PPO C-SNP | $0 | $6,850 | $700 | $2,750 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 036 TN (PPO C-SNP) | PPO C-SNP | $0 | $6,900 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 045 SC (PPO C-SNP) | PPO C-SNP | $0 | $7,150 | $700 | $2,500 | $350 | |
| DEVOTED C-SNP CHOICE PLUS 003 CT (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $1,500 | $200 | |
| DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 003 NH (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $1,000 | $200 | |
| DEVOTED C-SNP CHOICE PLUS 003 NJ (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,500 | $200 | |
| DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 004 KY (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 006 NE (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 006 SC (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $4,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 006 WA (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $2,500 | $250 | |
| DEVOTED C-SNP CHOICE PLUS 007 UT (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 008 OK (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $2,000 | $400 | |
| DEVOTED C-SNP CHOICE PLUS 010 AR (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,000 | $400 | |
| DEVOTED C-SNP CHOICE PLUS 010 MS (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $4,000 | $400 | |
| DEVOTED C-SNP CHOICE PLUS 012 AL (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 012 CT (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $1,500 | $200 | |
| DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,500 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $4,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 013 MI (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,500 | $250 | |
| DEVOTED C-SNP CHOICE PLUS 013 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 014 LA (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 014 MI (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,500 | $250 | |
| DEVOTED C-SNP CHOICE PLUS 014 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 015 AL (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $3,500 | $400 | |
| DEVOTED C-SNP CHOICE PLUS 015 NY (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $3,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 016 AL (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $3,500 | $400 | |
| DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $3,000 | $250 | |
| DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP CHOICE PLUS 024 LA (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,500 | $400 | |
| DEVOTED C-SNP CHOICE PLUS 031 TN (PPO C-SNP) | PPO C-SNP | $0 | $9,850 | $650 | $2,500 | $400 | |
| DEVOTED C-SNP ENHANCED 003 NM (HMO C-SNP) | HMO C-SNP | $0 | $4,600 | $461 | $2,500 | $200 | |
| DEVOTED C-SNP ENHANCED 003 VA (HMO C-SNP) | HMO C-SNP | $0 | $8,200 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 003 WA (HMO C-SNP) | HMO C-SNP | $0 | $7,050 | $650 | $2,000 | $200 | |
| DEVOTED C-SNP ENHANCED 005 IL (HMO C-SNP) | HMO C-SNP | $0 | $3,500 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 007 NM (HMO C-SNP) | HMO C-SNP | $0 | $4,800 | $461 | $2,500 | $200 | |
| DEVOTED C-SNP ENHANCED 008 WA (HMO C-SNP) | HMO C-SNP | $0 | $7,050 | $650 | $2,000 | $200 | |
| DEVOTED C-SNP ENHANCED 009 CO (HMO C-SNP) | HMO C-SNP | $0 | $4,700 | $461 | $2,000 | $250 | |
| DEVOTED C-SNP ENHANCED 010 CO (HMO C-SNP) | HMO C-SNP | $0 | $5,400 | $461 | $2,000 | $250 | |
| DEVOTED C-SNP ENHANCED 010 VA (HMO C-SNP) | HMO C-SNP | $0 | $6,200 | $461 | $2,500 | $300 | |
| DEVOTED C-SNP ENHANCED 011 CO (HMO C-SNP) | HMO C-SNP | $0 | $7,100 | $461 | $2,000 | $250 | |
| DEVOTED C-SNP ENHANCED 012 MO (HMO C-SNP) | HMO C-SNP | $0 | $3,500 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 013 MO (HMO C-SNP) | HMO C-SNP | $0 | $4,200 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 013 OR (HMO C-SNP) | HMO C-SNP | $0 | $6,400 | $650 | $2,000 | $200 | |
| DEVOTED C-SNP ENHANCED 013 VA (HMO C-SNP) | HMO C-SNP | $0 | $6,400 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 013 WA (HMO C-SNP) | HMO C-SNP | $0 | $7,250 | $650 | $2,000 | $200 | |
| DEVOTED C-SNP ENHANCED 014 AZ (HMO C-SNP) | HMO C-SNP | $0 | $5,000 | $465 | $1,500 | $300 | |
| DEVOTED C-SNP ENHANCED 014 MO (HMO C-SNP) | HMO C-SNP | $0 | $4,200 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 014 NC (HMO C-SNP) | HMO C-SNP | $0 | $6,200 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 015 MO (HMO C-SNP) | HMO C-SNP | $0 | $3,900 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 016 NC (HMO C-SNP) | HMO C-SNP | $0 | $5,400 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 016 PA (HMO C-SNP) | HMO C-SNP | $0 | $8,000 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 016 TN (HMO C-SNP) | HMO C-SNP | $0 | $5,700 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 017 NC (HMO C-SNP) | HMO C-SNP | $0 | $4,800 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 017 OH (HMO C-SNP) | HMO C-SNP | $0 | $5,100 | $461 | $2,500 | $400 | |
| DEVOTED C-SNP ENHANCED 017 PA (HMO C-SNP) | HMO C-SNP | $0 | $7,250 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 018 NC (HMO C-SNP) | HMO C-SNP | $0 | $5,600 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 018 OH (HMO C-SNP) | HMO C-SNP | $0 | $5,400 | $461 | $2,000 | $400 | |
| DEVOTED C-SNP ENHANCED 018 PA (HMO C-SNP) | HMO C-SNP | $0 | $7,000 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 019 PA (HMO C-SNP) | HMO C-SNP | $0 | $7,000 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 020 OH (HMO C-SNP) | HMO C-SNP | $0 | $5,700 | $461 | $2,000 | $400 | |
| DEVOTED C-SNP ENHANCED 020 PA (HMO C-SNP) | HMO C-SNP | $0 | $7,050 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 023 TX (HMO C-SNP) | HMO C-SNP | $0 | $6,200 | $650 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 027 MO (HMO C-SNP) | HMO C-SNP | $0 | $5,100 | $650 | $1,500 | $250 | |
| DEVOTED C-SNP ENHANCED 028 TX (HMO C-SNP) | HMO C-SNP | $0 | $4,250 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 030 TX (HMO C-SNP) | HMO C-SNP | $0 | $4,450 | $650 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 067 FL (HMO C-SNP) | HMO C-SNP | $0 | $4,400 | $465 | $2,500 | $300 | |
| DEVOTED C-SNP ENHANCED 068 FL (HMO C-SNP) | HMO C-SNP | $0 | $4,400 | $465 | $2,500 | $300 | |
| DEVOTED C-SNP ENHANCED 069 FL (HMO C-SNP) | HMO C-SNP | $0 | $4,400 | $465 | $2,500 | $300 | |
| DEVOTED C-SNP ENHANCED 069 TX (HMO C-SNP) | HMO C-SNP | $0 | $5,050 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP ENHANCED 070 FL (HMO C-SNP) | HMO C-SNP | $0 | $4,400 | $465 | $2,500 | $300 | |
| DEVOTED C-SNP ENHANCED 071 FL (HMO C-SNP) | HMO C-SNP | $0 | $5,300 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 072 FL (HMO C-SNP) | HMO C-SNP | $0 | $4,900 | $465 | $2,500 | $300 | |
| DEVOTED C-SNP ENHANCED 073 FL (HMO C-SNP) | HMO C-SNP | $0 | $4,400 | $465 | $2,000 | $300 | |
| DEVOTED C-SNP ENHANCED 074 FL (HMO C-SNP) | HMO C-SNP | $0 | $4,400 | $465 | $2,500 | $300 | |
| DEVOTED C-SNP ENHANCED 075 TX (HMO C-SNP) | HMO C-SNP | $0 | $6,250 | $650 | $2,000 | $350 | |
| DEVOTED C-SNP ENHANCED 092 AZ (HMO C-SNP) | HMO C-SNP | $0 | $3,400 | $650 | $2,000 | $250 | |
| DEVOTED C-SNP ENHANCED 096 AZ (HMO C-SNP) | HMO C-SNP | $0 | $3,550 | $650 | $2,000 | $250 | |
| DEVOTED C-SNP ENHANCED 100 AZ (HMO C-SNP) | HMO C-SNP | $0 | $6,550 | $650 | $2,000 | $250 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 004 WA (HMO C-SNP) | HMO C-SNP | $0 | $8,300 | $700 | $400 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 006 HI (HMO C-SNP) | HMO C-SNP | $0 | $7,800 | $700 | $400 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 007 HI (HMO C-SNP) | HMO C-SNP | $0 | $7,700 | $700 | $400 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 007 IL (HMO C-SNP) | HMO C-SNP | $0 | $5,900 | $700 | $3,250 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 009 WA (HMO C-SNP) | HMO C-SNP | $0 | $8,100 | $700 | $400 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 012 NM (HMO C-SNP) | HMO C-SNP | $0 | $5,850 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 013 NM (HMO C-SNP) | HMO C-SNP | $0 | $6,150 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 014 WA (HMO C-SNP) | HMO C-SNP | $0 | $8,200 | $700 | $250 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 016 CO (HMO C-SNP) | HMO C-SNP | $0 | $6,750 | $700 | $400 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 017 CO (HMO C-SNP) | HMO C-SNP | $0 | $7,000 | $700 | $400 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 017 MO (HMO C-SNP) | HMO C-SNP | $0 | $7,300 | $700 | $4,000 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 018 CO (HMO C-SNP) | HMO C-SNP | $0 | $8,400 | $700 | $350 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 018 MO (HMO C-SNP) | HMO C-SNP | $0 | $5,000 | $700 | $4,000 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 018 OR (HMO C-SNP) | HMO C-SNP | $0 | $7,900 | $700 | $350 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 019 OR (HMO C-SNP) | HMO C-SNP | $0 | $7,700 | $700 | $400 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 020 OR (HMO C-SNP) | HMO C-SNP | $0 | $7,950 | $700 | $400 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 021 MO (HMO C-SNP) | HMO C-SNP | $0 | $5,200 | $700 | $3,250 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 023 OH (HMO C-SNP) | HMO C-SNP | $0 | $6,800 | $700 | $3,000 | $300 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 024 OH (HMO C-SNP) | HMO C-SNP | $0 | $6,350 | $700 | $3,750 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 025 OH (HMO C-SNP) | HMO C-SNP | $0 | $6,400 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 026 VA (HMO C-SNP) | HMO C-SNP | $0 | $6,800 | $700 | $2,500 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 027 PA (HMO C-SNP) | HMO C-SNP | $0 | $8,400 | $700 | $3,000 | $250 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 027 VA (HMO C-SNP) | HMO C-SNP | $0 | $6,800 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 028 PA (HMO C-SNP) | HMO C-SNP | $0 | $7,100 | $700 | $3,750 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 028 VA (HMO C-SNP) | HMO C-SNP | $0 | $6,800 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 029 MO (HMO C-SNP) | HMO C-SNP | $0 | $5,100 | $700 | $4,000 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 029 PA (HMO C-SNP) | HMO C-SNP | $0 | $7,600 | $700 | $4,250 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 030 OR (HMO C-SNP) | HMO C-SNP | $0 | $7,900 | $700 | $350 | ||
| DEVOTED C-SNP GIVEBACK EXTRAS 030 PA (HMO C-SNP) | HMO C-SNP | $0 | $6,850 | $700 | $3,750 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 031 NC (HMO C-SNP) | HMO C-SNP | $0 | $7,050 | $700 | $4,250 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 031 PA (HMO C-SNP) | HMO C-SNP | $0 | $7,950 | $700 | $4,250 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 032 NC (HMO C-SNP) | HMO C-SNP | $0 | $5,700 | $700 | $2,500 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 033 NC (HMO C-SNP) | HMO C-SNP | $0 | $7,100 | $700 | $4,000 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 034 NC (HMO C-SNP) | HMO C-SNP | $0 | $7,150 | $700 | $4,000 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 045 NC (HMO C-SNP) | HMO C-SNP | $0 | $6,750 | $700 | $4,000 | $300 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 063 IA (HMO C-SNP) | HMO C-SNP | $0 | $5,900 | $700 | $3,250 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 082 TX (HMO C-SNP) | HMO C-SNP | $0 | $6,700 | $700 | $3,750 | $250 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 083 TX (HMO C-SNP) | HMO C-SNP | $0 | $7,150 | $700 | $4,000 | $250 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 085 TX (HMO C-SNP) | HMO C-SNP | $0 | $7,350 | $700 | $3,000 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 086 TX (HMO C-SNP) | HMO C-SNP | $0 | $8,650 | $700 | $2,500 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 087 TX (HMO C-SNP) | HMO C-SNP | $0 | $5,600 | $700 | $3,250 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 089 TX (HMO C-SNP) | HMO C-SNP | $0 | $6,600 | $700 | $4,250 | $350 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 102 AZ (HMO C-SNP) | HMO C-SNP | $0 | $5,650 | $700 | $3,250 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 103 AZ (HMO C-SNP) | HMO C-SNP | $0 | $7,850 | $700 | $2,000 | $400 | |
| DEVOTED C-SNP GIVEBACK EXTRAS 104 AZ (HMO C-SNP) | HMO C-SNP | $0 | $5,550 | $700 | $4,250 | $400 | |
| DEVOTED C-SNP PLUS 003 HI (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $300 | ||
| DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP PLUS 004 VA (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP PLUS 005 WA (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $2,500 | $250 | |
| DEVOTED C-SNP PLUS 006 IL (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $465 | $3,500 | $300 | |
| DEVOTED C-SNP PLUS 009 OR (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP PLUS 010 WA (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $2,500 | $250 | |
| DEVOTED C-SNP PLUS 013 CO (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $3,000 | $350 | |
| DEVOTED C-SNP PLUS 014 OR (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $2,500 | $200 | |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $3,000 | $300 | |
| DEVOTED C-SNP PLUS 015 WA (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $2,500 | $250 | |
| DEVOTED C-SNP PLUS 016 MO (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $4,000 | $400 | |
| DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP PLUS 022 PA (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $3,500 | $300 | |
| DEVOTED C-SNP PLUS 024 TX (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $2,000 | $300 | |
| DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $3,500 | $300 | |
| DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $2,000 | $300 | |
| DEVOTED C-SNP PLUS 029 TX (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $3,000 | $300 | |
| DEVOTED C-SNP PLUS 031 TX (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $3,000 | $300 | |
| DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $3,000 | $300 | |
| DEVOTED C-SNP PLUS 036 IA (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $4,000 | $300 | |
| DEVOTED C-SNP PLUS 070 TX (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $2,500 | $400 | |
| DEVOTED C-SNP PLUS 084 FL (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $3,500 | $300 | |
| DEVOTED C-SNP PLUS 085 FL (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $465 | $3,500 | $300 | |
| DEVOTED C-SNP PLUS 086 FL (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $465 | $3,500 | $300 | |
| DEVOTED C-SNP PLUS 087 FL (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $465 | $4,000 | $300 | |
| DEVOTED C-SNP PLUS 088 FL (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $465 | $4,000 | $300 | |
| DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $465 | $4,000 | $300 | |
| DEVOTED C-SNP PLUS 090 FL (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $461 | $3,500 | $300 | |
| DEVOTED C-SNP PLUS 091 FL (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $465 | $4,000 | $300 | |
| DEVOTED C-SNP PLUS 093 AZ (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $4,000 | $300 | |
| DEVOTED C-SNP PLUS 097 AZ (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $4,000 | $300 | |
| DEVOTED C-SNP PLUS 101 AZ (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $2,500 | $300 | |
| DEVOTED C-SNP PLUS 117 TX (HMO C-SNP) | HMO C-SNP | $0 | $9,850 | $650 | $2,500 | $400 | |
| DEVOTED CHOICE 001 AL (PPO) | PPO | $0 | $6,200 | $650 | $2,750 | $400 | |
| DEVOTED CHOICE 001 AR (PPO) | PPO | $0 | $5,700 | $650 | $3,500 | $350 | |
| DEVOTED CHOICE 001 AZ (PPO) | PPO | $0 | $5,900 | $650 | $1,500 | $150 | |
| DEVOTED CHOICE 001 CO (PPO) | PPO | $0 | $6,050 | $461 | $300 | ||
| DEVOTED CHOICE 001 CT (PPO) | PPO | $0 | $6,250 | $650 | $1,750 | $250 | |
| DEVOTED CHOICE 001 DE (PPO) | PPO | $0 | $7,250 | $650 | $3,500 | $350 | |
| DEVOTED CHOICE 001 GA (PPO) | PPO | $0 | $7,400 | $461 | $3,500 | $350 | |
| DEVOTED CHOICE 001 IL (PPO) | PPO | $0 | $5,000 | $465 | $3,500 | $400 | |
| DEVOTED CHOICE 001 IN (PPO) | PPO | $0 | $4,850 | $650 | $2,000 | $300 | |
| DEVOTED CHOICE 001 KS (PPO) | PPO | $0 | $3,950 | $650 | $3,500 | $400 | |
| DEVOTED CHOICE 001 KY (PPO) | PPO | $0 | $6,050 | $650 | $3,500 | $350 | |
| DEVOTED CHOICE 001 LA (PPO) | PPO | $0 | $4,650 | $650 | $3,750 | $350 | |
| DEVOTED CHOICE 001 MI (PPO) | PPO | $0 | $6,450 | $650 | $2,750 | $400 | |
| DEVOTED CHOICE 001 MO (PPO) | PPO | $0 | $3,950 | $650 | $3,250 | $400 | |
| DEVOTED CHOICE 001 MS (PPO) | PPO | $0 | $5,400 | $650 | $3,500 | $350 | |
| DEVOTED CHOICE 001 NC (PPO) | PPO | $0 | $6,150 | $461 | $3,000 | $300 | |
| DEVOTED CHOICE 001 NE (PPO) | PPO | $0 | $4,800 | $650 | $3,000 | $350 | |
| DEVOTED CHOICE 001 NH (PPO) | PPO | $0 | $6,800 | $650 | $1,750 | $150 | |
| DEVOTED CHOICE 001 NJ (PPO) | PPO | $0 | $9,350 | $650 | $1,750 | $300 | |
| DEVOTED CHOICE 001 NY (PPO) | PPO | $0 | $9,500 | $650 | $1,750 | $100 | |
| DEVOTED CHOICE 001 OH (PPO) | PPO | $0 | $5,300 | $650 | $1,500 | $350 | |
| DEVOTED CHOICE 001 OK (PPO) | PPO | $0 | $5,700 | $650 | $2,500 | $300 | |
| DEVOTED CHOICE 001 SC (PPO) | PPO | $0 | $7,050 | $650 | $2,250 | $300 | |
| DEVOTED CHOICE 001 UT (PPO) | PPO | $0 | $6,350 | $650 | $3,500 | $300 | |
| DEVOTED CHOICE 001 WA (PPO) | PPO | $0 | $7,500 | $461 | $400 | ||
| DEVOTED CHOICE 002 AL (PPO) | PPO | $0 | $5,900 | $650 | $2,750 | $400 | |
| DEVOTED CHOICE 002 AZ (PPO) | PPO | $0 | $6,100 | $465 | $2,500 | $200 | |
| DEVOTED CHOICE 002 CO (PPO) | PPO | $0 | $6,050 | $650 | $300 | ||
| DEVOTED CHOICE 003 AZ (PPO) | PPO | $0 | $5,900 | $461 | $2,500 | $300 | |
| DEVOTED CHOICE 003 IL (PPO) | PPO | $0 | $4,150 | $650 | $3,000 | $200 | |
| DEVOTED CHOICE 003 KY (PPO) | PPO | $0 | $6,050 | $650 | $3,500 | $350 | |
| DEVOTED CHOICE 003 NC (PPO) | PPO | $0 | $4,850 | $650 | $2,500 | $300 | |
| DEVOTED CHOICE 003 NY (PPO) | PPO | $0 | $9,500 | $650 | $1,750 | $100 | |
| DEVOTED CHOICE 003 OH (PPO) | PPO | $0 | $5,300 | $650 | $2,500 | $250 | |
| DEVOTED CHOICE 004 GA (PPO) | PPO | $0 | $7,850 | $650 | $3,500 | $350 | |
| DEVOTED CHOICE 004 HI (PPO) | PPO | $0 | $7,050 | $650 | $1,000 | $200 | |
| DEVOTED CHOICE 005 CO (PPO) | PPO | $0 | $6,000 | $650 | $300 | ||
| DEVOTED CHOICE 005 IL (PPO) | PPO | $0 | $4,450 | $650 | $3,250 | $200 | |
| DEVOTED CHOICE 005 IN (PPO) | PPO | $0 | $4,800 | $465 | $2,000 | $300 | |
| DEVOTED CHOICE 005 KS (PPO) | PPO | $0 | $3,950 | $650 | $3,500 | $400 | |
| DEVOTED CHOICE 005 LA (PPO) | PPO | $0 | $3,900 | $650 | $4,000 | $350 | |
| DEVOTED CHOICE 005 MI (PPO) | PPO | $0 | $6,450 | $650 | $2,750 | $400 | |
| DEVOTED CHOICE 005 NC (PPO) | PPO | $0 | $5,300 | $650 | $2,500 | $300 | |
| DEVOTED CHOICE 005 OK (PPO) | PPO | $0 | $5,850 | $650 | $3,750 | $300 | |
| DEVOTED CHOICE 007 AL (PPO) | PPO | $0 | $5,600 | $650 | $2,750 | $400 | |
| DEVOTED CHOICE 007 NY (PPO) | PPO | $0 | $9,350 | $650 | $1,750 | $300 | |
| DEVOTED CHOICE 007 PA (PPO) | PPO | $0 | $7,100 | $650 | $2,500 | $200 | |
| DEVOTED CHOICE 008 AL (PPO) | PPO | $0 | $5,600 | $650 | $2,750 | $400 | |
| DEVOTED CHOICE 008 HI (PPO) | PPO | $0 | $6,900 | $461 | $200 | ||
| DEVOTED CHOICE 008 IN (PPO) | PPO | $0 | $4,900 | $650 | $4,000 | $300 | |
| DEVOTED CHOICE 008 NC (PPO) | PPO | $0 | $5,900 | $650 | $2,500 | $300 | |
| DEVOTED CHOICE 009 NY (PPO) | PPO | $0 | $9,500 | $650 | $1,750 | $150 | |
| DEVOTED CHOICE 010 CT (PPO) | PPO | $0 | $6,250 | $650 | $1,750 | $250 | |
| DEVOTED CHOICE 010 GA (PPO) | PPO | $0 | $7,850 | $461 | $3,500 | $350 | |
| DEVOTED CHOICE 010 IL (PPO) | PPO | $0 | $5,400 | $650 | $3,000 | $400 | |
| DEVOTED CHOICE 010 PA (PPO) | PPO | $0 | $6,600 | $461 | $3,000 | $350 | |
| DEVOTED CHOICE 011 IN (PPO) | PPO | $0 | $4,550 | $650 | $4,000 | $300 | |
| DEVOTED CHOICE 015 FL (PPO) | PPO | $0 | $6,150 | $650 | $1,750 | $200 | |
| DEVOTED CHOICE 015 TN (PPO) | PPO | $0 | $6,400 | $650 | $2,250 | $400 | |
| DEVOTED CHOICE 016 LA (PPO) | PPO | $0 | $6,050 | $650 | $2,250 | $175 | |
| DEVOTED CHOICE 022 TN (PPO) | PPO | $0 | $5,700 | $650 | $2,750 | $350 | |
| DEVOTED CHOICE 023 TN (PPO) | PPO | $0 | $5,550 | $650 | $4,000 | $350 | |
| DEVOTED CHOICE 024 TN (PPO) | PPO | $0 | $5,650 | $650 | $4,000 | $350 | |
| DEVOTED CHOICE 026 TN (PPO) | PPO | $0 | $5,700 | $650 | $2,250 | $400 | |
| DEVOTED CHOICE GIVEBACK 001 TX (PPO) | PPO | $0 | $8,550 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 AR (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 CT (PPO) | PPO | $0 | $8,650 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 DE (PPO) | PPO | $0 | $9,850 | $461 | $500 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 GA (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 IL (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 IN (PPO) | PPO | $0 | $9,650 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 KS (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 KY (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 LA (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 MI (PPO) | PPO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 MO (PPO) | PPO | $0 | $7,150 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 MS (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | PPO | $0 | $9,250 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 NE (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 NH (PPO) | PPO | $0 | $8,650 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 NJ (PPO) | PPO | $0 | $9,850 | $650 | $250 | $375 | |
| DEVOTED CHOICE GIVEBACK 002 NY (PPO) | PPO | $0 | $9,850 | $650 | $250 | $400 | |
| DEVOTED CHOICE GIVEBACK 002 OK (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 SC (PPO) | PPO | $0 | $7,750 | $461 | $750 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 TN (PPO) | PPO | $0 | $9,300 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 UT (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 002 WA (PPO) | PPO | $0 | $9,850 | $461 | $200 | ||
| DEVOTED CHOICE GIVEBACK 003 CO (PPO) | PPO | $0 | $8,950 | $461 | $200 | ||
| DEVOTED CHOICE GIVEBACK 003 PA (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 004 IL (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | PPO | $0 | $9,250 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 004 NY (PPO) | PPO | $0 | $9,850 | $650 | $250 | $400 | |
| DEVOTED CHOICE GIVEBACK 005 AL (PPO) | PPO | $0 | $8,900 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 005 GA (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 005 HI (PPO) | PPO | $0 | $9,450 | $461 | $250 | $100 | |
| DEVOTED CHOICE GIVEBACK 005 TN (PPO) | PPO | $0 | $9,350 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 AL (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 AZ (PPO) | PPO | $0 | $9,450 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 IL (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 IN (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 KS (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 LA (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 MI (PPO) | PPO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | PPO | $0 | $9,850 | $465 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 OK (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 006 TN (PPO) | PPO | $0 | $9,300 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 008 FL (PPO) | PPO | $0 | $9,850 | $461 | $1,250 | $350 | |
| DEVOTED CHOICE GIVEBACK 008 NY (PPO) | PPO | $0 | $9,850 | $650 | $250 | $400 | |
| DEVOTED CHOICE GIVEBACK 008 PA (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 009 AL (PPO) | PPO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 009 HI (PPO) | PPO | $0 | $9,300 | $461 | $200 | ||
| DEVOTED CHOICE GIVEBACK 009 IN (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 010 AL (PPO) | PPO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 010 NY (PPO) | PPO | $0 | $9,850 | $650 | $250 | $400 | |
| DEVOTED CHOICE GIVEBACK 011 CT (PPO) | PPO | $0 | $8,650 | $650 | $250 | $300 | |
| DEVOTED CHOICE GIVEBACK 011 GA (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 011 PA (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 012 IN (PPO) | PPO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 012 TN (PPO) | PPO | $0 | $9,300 | $461 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 013 FL (PPO) | PPO | $0 | $9,850 | $461 | $1,000 | $200 | |
| DEVOTED CHOICE GIVEBACK 016 FL (PPO) | PPO | $0 | $7,150 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 017 LA (PPO) | PPO | $0 | $8,150 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 019 TN (PPO) | PPO | $0 | $8,400 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 020 TN (PPO) | PPO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 021 TN (PPO) | PPO | $0 | $8,700 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK 025 TN (PPO) | PPO | $0 | $8,700 | $650 | $250 | $200 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 005 DE (PPO) | PPO | $0 | $8,450 | $700 | $2,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 005 MO (PPO) | PPO | $0 | $5,450 | $700 | $4,000 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 006 NH (PPO) | PPO | $0 | $7,650 | $700 | $2,000 | $200 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 006 NJ (PPO) | PPO | $0 | $9,650 | $700 | $2,000 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 009 CT (PPO) | PPO | $0 | $7,400 | $700 | $2,000 | $300 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 010 KY (PPO) | PPO | $0 | $7,850 | $700 | $2,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 011 KY (PPO) | PPO | $0 | $7,850 | $700 | $2,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 011 NE (PPO) | PPO | $0 | $7,250 | $700 | $3,250 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 012 AR (PPO) | PPO | $0 | $7,600 | $700 | $3,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 012 MS (PPO) | PPO | $0 | $7,500 | $700 | $2,500 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 013 OK (PPO) | PPO | $0 | $7,650 | $700 | $2,000 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 014 OK (PPO) | PPO | $0 | $7,750 | $700 | $4,000 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 014 UT (PPO) | PPO | $0 | $8,000 | $700 | $3,750 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 015 MI (PPO) | PPO | $0 | $8,050 | $700 | $3,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 017 FL (PPO) | PPO | $0 | $7,750 | $700 | $2,000 | $250 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 017 MI (PPO) | PPO | $0 | $8,050 | $700 | $3,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 018 CT (PPO) | PPO | $0 | $7,400 | $700 | $2,000 | $300 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 018 IL (PPO) | PPO | $0 | $7,300 | $700 | $3,750 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 019 IL (PPO) | PPO | $0 | $6,850 | $700 | $3,250 | $250 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 020 IL (PPO) | PPO | $0 | $7,000 | $700 | $3,500 | $250 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 022 GA (PPO) | PPO | $0 | $8,550 | $700 | $2,500 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 022 KS (PPO) | PPO | $0 | $7,000 | $700 | $3,750 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 023 GA (PPO) | PPO | $0 | $8,900 | $700 | $2,500 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 023 IN (PPO) | PPO | $0 | $7,300 | $700 | $4,250 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 023 KS (PPO) | PPO | $0 | $5,450 | $700 | $3,000 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 024 GA (PPO) | PPO | $0 | $8,900 | $700 | $2,500 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 024 IN (PPO) | PPO | $0 | $7,100 | $700 | $2,250 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 025 IN (PPO) | PPO | $0 | $7,350 | $700 | $2,250 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 026 IN (PPO) | PPO | $0 | $7,500 | $700 | $4,250 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 027 LA (PPO) | PPO | $0 | $7,000 | $700 | $4,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 028 LA (PPO) | PPO | $0 | $6,600 | $700 | $3,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 028 NY (PPO) | PPO | $0 | $9,750 | $700 | $2,000 | $150 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 029 LA (PPO) | PPO | $0 | $7,050 | $700 | $2,200 | $225 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 029 NY (PPO) | PPO | $0 | $9,750 | $700 | $2,000 | $150 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 031 NY (PPO) | PPO | $0 | $9,650 | $700 | $2,000 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 032 NY (PPO) | PPO | $0 | $9,750 | $700 | $2,000 | $200 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 038 AL (PPO) | PPO | $0 | $7,250 | $700 | $2,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 039 AL (PPO) | PPO | $0 | $7,700 | $700 | $2,000 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 040 SC (PPO) | PPO | $0 | $7,150 | $700 | $2,500 | $350 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 041 TN (PPO) | PPO | $0 | $6,800 | $700 | $2,250 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 042 TN (PPO) | PPO | $0 | $7,400 | $700 | $2,500 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 043 TN (PPO) | PPO | $0 | $6,850 | $700 | $2,750 | $400 | |
| DEVOTED CHOICE GIVEBACK EXTRAS 044 TN (PPO) | PPO | $0 | $6,900 | $700 | $2,000 | $400 | |
| DEVOTED CHOICE MA ONLY 002 OH (PPO) | PPO | $9,250 | $1,000 | $400 | |||
| DEVOTED CHOICE MA ONLY 003 GA (PPO) | PPO | $9,250 | $1,000 | $400 | |||
| DEVOTED CHOICE MA ONLY 003 SC (PPO) | PPO | $9,250 | $1,000 | $400 | |||
| DEVOTED CHOICE MA ONLY 004 CO (PPO) | PPO | $7,900 | $400 | ||||
| DEVOTED CHOICE MA ONLY 005 AZ (PPO) | PPO | $7,000 | $1,000 | $400 | |||
| DEVOTED CHOICE MA ONLY 006 TX (PPO) | PPO | $9,250 | $1,000 | $400 | |||
| DEVOTED CHOICE MA ONLY 007 AL (PPO) | PPO | $7,900 | $1,000 | $400 | |||
| DEVOTED CHOICE MA ONLY 007 HI (PPO) | PPO | $9,250 | $400 | ||||
| DEVOTED CHOICE MA ONLY 007 NC (PPO) | PPO | $9,250 | $1,000 | $400 | |||
| DEVOTED CHOICE MA ONLY 014 FL (PPO) | PPO | $9,250 | $1,000 | $400 | |||
| DEVOTED CHOICE PREMIUM 002 OR (PPO) | PPO | $28.50 | $6,000 | $650 | $200 | ||
| DEVOTED CHOICE PREMIUM 004 IN (PPO) | PPO | $11 | $4,500 | $650 | $3,000 | $400 | |
| DEVOTED CHOICE PREMIUM 006 HI (PPO) | PPO | $69 | $6,700 | $650 | $2,500 | $150 | |
| DEVOTED CHOICE PREMIUM 007 IN (PPO) | PPO | $10 | $5,900 | $650 | $3,000 | $400 | |
| DEVOTED CHOICE PREMIUM 010 HI (PPO) | PPO | $57.70 | $6,700 | $650 | $150 | ||
| DEVOTED CORE 001 AL (HMO) | HMO | $0 | $5,700 | $465 | $2,750 | $400 | |
| DEVOTED CORE 001 AZ (HMO) | HMO | $0 | $4,500 | $650 | $1,000 | $200 | |
| DEVOTED CORE 001 CO (HMO) | HMO | $0 | $4,900 | $461 | $350 | ||
| DEVOTED CORE 001 FL (HMO) | HMO | $0 | $3,900 | $600 | $1,500 | $350 | |
| DEVOTED CORE 001 IL (HMO) | HMO | $0 | $2,700 | $650 | $3,000 | $400 | |
| DEVOTED CORE 001 MO (HMO) | HMO | $0 | $3,100 | $650 | $3,750 | $300 | |
| DEVOTED CORE 001 NC (HMO) | HMO | $0 | $4,050 | $650 | $2,250 | $300 | |
| DEVOTED CORE 001 NM (HMO) | HMO | $0 | $4,100 | $650 | $2,750 | $400 | |
| DEVOTED CORE 001 OH (HMO) | HMO | $0 | $4,900 | $650 | $1,750 | $200 | |
| DEVOTED CORE 001 OR (HMO) | HMO | $0 | $6,700 | $461 | $400 | ||
| DEVOTED CORE 001 SC (HMO) | HMO | $0 | $5,900 | $650 | $2,250 | $300 | |
| DEVOTED CORE 001 TN (HMO) | HMO | $0 | $4,300 | $650 | $3,000 | $350 | |
| DEVOTED CORE 001 TX (HMO) | HMO | $0 | $3,700 | $650 | $3,000 | $350 | |
| DEVOTED CORE 001 VA (HMO) | HMO | $0 | $5,900 | $650 | $3,000 | $300 | |
| DEVOTED CORE 001 WA (HMO) | HMO | $0 | $6,550 | $650 | $400 | ||
| DEVOTED CORE 002 FL (HMO) | HMO | $0 | $3,950 | $650 | $1,500 | $150 | |
| DEVOTED CORE 003 FL (HMO) | HMO | $0 | $3,950 | $650 | $1,500 | $150 | |
| DEVOTED CORE 003 MO (HMO) | HMO | $0 | $3,600 | $650 | $3,750 | $300 | |
| DEVOTED CORE 003 TX (HMO) | HMO | $0 | $3,900 | $461 | $4,000 | $300 | |
| DEVOTED CORE 004 CO (HMO) | HMO | $0 | $4,450 | $465 | $350 | ||
| DEVOTED CORE 004 HI (HMO) | HMO | $0 | $6,600 | $650 | $350 | ||
| DEVOTED CORE 004 OH (HMO) | HMO | $0 | $4,950 | $650 | $2,000 | $250 | |
| DEVOTED CORE 004 TN (HMO) | HMO | $0 | $4,900 | $650 | $4,000 | $350 | |
| DEVOTED CORE 005 FL (HMO) | HMO | $0 | $3,950 | $650 | $1,500 | $350 | |
| DEVOTED CORE 005 HI (HMO) | HMO | $0 | $6,600 | $650 | $350 | ||
| DEVOTED CORE 005 MO (HMO) | HMO | $0 | $2,900 | $461 | $3,750 | $300 | |
| DEVOTED CORE 005 NM (HMO) | HMO | $0 | $4,750 | $650 | $2,500 | $400 | |
| DEVOTED CORE 006 WA (HMO) | HMO | $0 | $6,550 | $650 | $400 | ||
| DEVOTED CORE 007 AZ (HMO) | HMO | $0 | $6,750 | $650 | $750 | $200 | |
| DEVOTED CORE 007 OH (HMO) | HMO | $0 | $5,500 | $650 | $2,000 | $250 | |
| DEVOTED CORE 007 TN (HMO) | HMO | $0 | $6,400 | $650 | $2,500 | $250 | |
| DEVOTED CORE 007 TX (HMO) | HMO | $0 | $3,450 | $650 | $3,500 | $400 | |
| DEVOTED CORE 008 PA (HMO) | HMO | $0 | $6,750 | $650 | $3,500 | $400 | |
| DEVOTED CORE 008 VA (HMO) | HMO | $0 | $5,850 | $650 | $3,500 | $350 | |
| DEVOTED CORE 009 MO (HMO) | HMO | $0 | $3,200 | $650 | $3,000 | $300 | |
| DEVOTED CORE 009 TN (HMO) | HMO | $0 | $4,500 | $650 | $3,000 | $350 | |
| DEVOTED CORE 010 PA (HMO) | HMO | $0 | $5,900 | $650 | $4,000 | $350 | |
| DEVOTED CORE 010 TN (HMO) | HMO | $0 | $3,900 | $650 | $3,000 | $350 | |
| DEVOTED CORE 011 OR (HMO) | HMO | $0 | $5,900 | $650 | $350 | ||
| DEVOTED CORE 011 VA (HMO) | HMO | $0 | $5,900 | $650 | $3,500 | $350 | |
| DEVOTED CORE 011 WA (HMO) | HMO | $0 | $6,750 | $650 | $200 | ||
| DEVOTED CORE 012 PA (HMO) | HMO | $0 | $6,250 | $650 | $3,500 | $350 | |
| DEVOTED CORE 014 CO (HMO) | HMO | $0 | $6,600 | $650 | $300 | ||
| DEVOTED CORE 014 PA (HMO) | HMO | $0 | $6,550 | $650 | $4,000 | $350 | |
| DEVOTED CORE 014 TX (HMO) | HMO | $0 | $5,400 | $461 | $3,500 | $200 | |
| DEVOTED CORE 015 OH (HMO) | HMO | $0 | $4,900 | $650 | $3,500 | $350 | |
| DEVOTED CORE 019 OH (HMO) | HMO | $0 | $5,450 | $650 | $3,500 | $250 | |
| DEVOTED CORE 019 TX (HMO) | HMO | $0 | $3,650 | $650 | $3,000 | $350 | |
| DEVOTED CORE 020 AZ (HMO) | HMO | $0 | $5,900 | $465 | $1,500 | $200 | |
| DEVOTED CORE 021 AZ (HMO) | HMO | $0 | $2,950 | $461 | $3,500 | $250 | |
| DEVOTED CORE 021 NC (HMO) | HMO | $0 | $4,950 | $650 | $3,750 | $250 | |
| DEVOTED CORE 022 OH (HMO) | HMO | $0 | $4,750 | $650 | $3,500 | $350 | |
| DEVOTED CORE 023 MO (HMO) | HMO | $0 | $4,600 | $650 | $3,750 | $300 | |
| DEVOTED CORE 023 NC (HMO) | HMO | $0 | $4,700 | $650 | $3,750 | $300 | |
| DEVOTED CORE 023 PA (HMO) | HMO | $0 | $7,500 | $650 | $2,750 | $200 | |
| DEVOTED CORE 025 FL (HMO) | HMO | $0 | $3,950 | $650 | $1,500 | $150 | |
| DEVOTED CORE 026 OR (HMO) | HMO | $0 | $7,100 | $461 | $1,000 | $300 | |
| DEVOTED CORE 027 FL (HMO) | HMO | $0 | $3,950 | $650 | $1,500 | $350 | |
| DEVOTED CORE 029 FL (HMO) | HMO | $0 | $4,950 | $650 | $1,500 | $150 | |
| DEVOTED CORE 029 NC (HMO) | HMO | $0 | $4,950 | $650 | $3,750 | $300 | |
| DEVOTED CORE 034 IA (HMO) | HMO | $0 | $4,750 | $650 | $3,000 | $350 | |
| DEVOTED CORE 036 FL (HMO) | HMO | $0 | $3,950 | $650 | $1,500 | $150 | |
| DEVOTED CORE 037 FL (HMO) | HMO | $0 | $3,900 | $650 | $1,500 | $150 | |
| DEVOTED CORE 037 NC (HMO) | HMO | $0 | $4,950 | $650 | $4,000 | $300 | |
| DEVOTED CORE 046 FL (HMO) | HMO | $0 | $4,950 | $650 | $1,500 | $150 | |
| DEVOTED CORE 050 FL (HMO) | HMO | $0 | $4,950 | $650 | $1,500 | $150 | |
| DEVOTED CORE 056 FL (HMO) | HMO | $0 | $3,900 | $465 | $3,500 | $400 | |
| DEVOTED CORE 057 FL (HMO) | HMO | $0 | $4,700 | $650 | $3,500 | $400 | |
| DEVOTED CORE 058 FL (HMO) | HMO | $0 | $3,900 | $650 | $3,750 | $400 | |
| DEVOTED CORE 059 FL (HMO) | HMO | $0 | $4,800 | $650 | $3,500 | $400 | |
| DEVOTED CORE 060 FL (HMO) | HMO | $0 | $3,900 | $650 | $3,750 | $400 | |
| DEVOTED CORE 061 FL (HMO) | HMO | $0 | $3,900 | $650 | $3,750 | $200 | |
| DEVOTED CORE 062 FL (HMO) | HMO | $0 | $3,400 | $465 | $3,500 | $400 | |
| DEVOTED CORE 063 FL (HMO) | HMO | $0 | $3,900 | $650 | $3,500 | $400 | |
| DEVOTED CORE 064 FL (HMO) | HMO | $0 | $3,900 | $650 | $3,500 | $400 | |
| DEVOTED CORE 065 FL (HMO) | HMO | $0 | $3,900 | $650 | $3,500 | $400 | |
| DEVOTED CORE 066 FL (HMO) | HMO | $0 | $4,700 | $650 | $3,500 | $400 | |
| DEVOTED CORE 067 TX (HMO) | HMO | $0 | $4,550 | $650 | $3,750 | $200 | |
| DEVOTED CORE 073 TX (HMO) | HMO | $0 | $5,750 | $650 | $2,750 | $350 | |
| DEVOTED CORE 090 AZ (HMO) | HMO | $0 | $2,900 | $650 | $4,000 | $350 | |
| DEVOTED CORE 092 FL (HMO) | HMO | $0 | $3,800 | $650 | $3,750 | $400 | |
| DEVOTED CORE 094 AZ (HMO) | HMO | $0 | $3,050 | $650 | $3,000 | $350 | |
| DEVOTED CORE 098 AZ (HMO) | HMO | $0 | $6,050 | $650 | $1,750 | $350 | |
| DEVOTED DUAL 004 AL (HMO D-SNP) | HMO D-SNP | $0 | $6,100 | $700 | $1,500 | $200 | |
| DEVOTED DUAL 007 AL (HMO D-SNP) | HMO D-SNP | $0 | $6,100 | $700 | $1,500 | $200 | |
| DEVOTED DUAL 007 CO (HMO D-SNP) | HMO D-SNP | $0 | $4,450 | $700 | $2,000 | $350 | |
| DEVOTED DUAL 008 MO (HMO D-SNP) | HMO D-SNP | $0 | $3,600 | $700 | $2,000 | $400 | |
| DEVOTED DUAL 009 NC (HMO D-SNP) | HMO D-SNP | $0 | $6,750 | $700 | $2,000 | $350 | |
| DEVOTED DUAL 010 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 012 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $300 | |
| DEVOTED DUAL 015 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 017 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $300 | |
| DEVOTED DUAL 019 FL (HMO D-SNP) | HMO D-SNP | $0 | $4,400 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 020 FL (HMO D-SNP) | HMO D-SNP | $0 | $4,400 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 021 FL (HMO D-SNP) | HMO D-SNP | $0 | $4,400 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 022 FL (HMO D-SNP) | HMO D-SNP | $0 | $4,400 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 023 FL (HMO D-SNP) | HMO D-SNP | $0 | $5,300 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 024 FL (HMO D-SNP) | HMO D-SNP | $0 | $4,400 | $700 | $3,000 | $400 | |
| DEVOTED DUAL 033 FL (HMO D-SNP) | HMO D-SNP | $0 | $4,400 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 034 FL (HMO D-SNP) | HMO D-SNP | $0 | $4,400 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 039 FL (HMO D-SNP) | HMO D-SNP | $0 | $5,200 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 041 FL (HMO D-SNP) | HMO D-SNP | $0 | $5,200 | $700 | $2,500 | $400 | |
| DEVOTED DUAL 043 FL (HMO D-SNP) | HMO D-SNP | $0 | $7,200 | $700 | $2,000 | $400 | |
| DEVOTED DUAL 071 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $300 | $2,500 | $400 | |
| DEVOTED DUAL 118 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $300 | $2,500 | $400 | |
| DEVOTED DUAL CHOICE 004 AR (PPO D-SNP) | PPO D-SNP | $0 | $5,900 | $700 | $2,000 | $400 | |
| DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) | PPO D-SNP | $0 | $4,900 | $700 | $2,000 | $400 | |
| DEVOTED DUAL CHOICE 004 MS (PPO D-SNP) | PPO D-SNP | $0 | $5,900 | $700 | $2,000 | $375 | |
| DEVOTED DUAL CHOICE 004 NE (PPO D-SNP) | PPO D-SNP | $0 | $4,900 | $700 | $2,000 | $400 | |
| DEVOTED DUAL CHOICE 023 LA (PPO D-SNP) | PPO D-SNP | $0 | $6,550 | $700 | $2,000 | $350 | |
| DEVOTED DUAL CHOICE FULL 003 OK (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL CHOICE FULL 004 UT (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $3,000 | $300 | |
| DEVOTED DUAL CHOICE FULL 008 NE (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $3,000 | $400 | |
| DEVOTED DUAL CHOICE FULL 009 AR (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $3,000 | $400 | |
| DEVOTED DUAL CHOICE FULL 009 MS (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $4,000 | $400 | |
| DEVOTED DUAL CHOICE FULL 011 AL (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $3,500 | $400 | |
| DEVOTED DUAL CHOICE FULL 012 AL (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $3,500 | $400 | |
| DEVOTED DUAL CHOICE FULL 013 AL (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $3,000 | $400 | |
| DEVOTED DUAL CHOICE FULL 014 AL (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $3,000 | $400 | |
| DEVOTED DUAL CHOICE FULL 015 LA (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $3,500 | $400 | |
| DEVOTED DUAL CHOICE FULL 022 LA (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $2,700 | $400 | |
| DEVOTED DUAL CHOICE PLUS 003 AR (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED DUAL CHOICE PLUS 003 MS (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL CHOICE QMB 025 LA (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL CHOICE QMB 026 LA (PPO D-SNP) | PPO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL FULL 011 MO (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED DUAL FULL 012 CO (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,000 | $350 | |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,000 | $350 | |
| DEVOTED DUAL FULL 025 PA (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,500 | $400 | |
| DEVOTED DUAL FULL 026 PA (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL FULL 037 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,000 | $400 | |
| DEVOTED DUAL FULL 038 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,000 | $300 | |
| DEVOTED DUAL FULL 040 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,000 | $400 | |
| DEVOTED DUAL FULL 041 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,000 | $300 | |
| DEVOTED DUAL FULL 072 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $400 | $2,500 | $400 | |
| DEVOTED DUAL FULL 077 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,500 | $400 | |
| DEVOTED DUAL FULL 078 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,500 | $400 | |
| DEVOTED DUAL FULL 079 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,500 | $400 | |
| DEVOTED DUAL FULL 080 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $4,000 | $400 | |
| DEVOTED DUAL FULL 081 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $4,000 | $400 | |
| DEVOTED DUAL FULL 082 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $4,000 | $400 | |
| DEVOTED DUAL FULL 083 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $3,500 | $400 | |
| DEVOTED DUAL FULL 096 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $4,000 | $400 | |
| DEVOTED DUAL FULL 098 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED DUAL FULL 100 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED DUAL FULL 101 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $4,000 | $400 | |
| DEVOTED DUAL FULL 103 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $600 | $2,500 | $400 | |
| DEVOTED DUAL FULL 104 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED DUAL FULL 119 TX (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $400 | $2,500 | $400 | |
| DEVOTED DUAL PLUS 003 AL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,000 | $200 | |
| DEVOTED DUAL PLUS 003 CO (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $1,500 | $350 | |
| DEVOTED DUAL PLUS 005 PA (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL PLUS 006 AL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,000 | $100 | |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,000 | $350 | |
| DEVOTED DUAL PLUS 007 MO (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL PLUS 007 PA (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL QMB 042 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL QMB 052 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,000 | $400 | |
| DEVOTED DUAL QMB 053 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED DUAL QMB 054 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED DUAL QMB 055 FL (HMO D-SNP) | HMO D-SNP | $0 | $9,850 | $700 | $2,500 | $400 | |
| DEVOTED GIVEBACK 001 HI (HMO) | HMO | $0 | $9,450 | $461 | $200 | ||
| DEVOTED GIVEBACK 002 AL (HMO) | HMO | $0 | $9,850 | $461 | $250 | $100 | |
| DEVOTED GIVEBACK 002 HI (HMO) | HMO | $0 | $9,300 | $461 | $200 | ||
| DEVOTED GIVEBACK 002 MO (HMO) | HMO | $0 | $7,150 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 002 NC (HMO) | HMO | $0 | $7,950 | $461 | $500 | $200 | |
| DEVOTED GIVEBACK 002 NM (HMO) | HMO | $0 | $8,000 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 002 TN (HMO) | HMO | $0 | $7,700 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 002 VA (HMO) | HMO | $0 | $8,200 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 002 WA (HMO) | HMO | $0 | $9,850 | $650 | $200 | ||
| DEVOTED GIVEBACK 003 IL (HMO) | HMO | $0 | $9,850 | $461 | $250 | $100 | |
| DEVOTED GIVEBACK 003 OH (HMO) | HMO | $0 | $8,000 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 004 MO (HMO) | HMO | $0 | $7,150 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 005 TN (HMO) | HMO | $0 | $7,700 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 006 MO (HMO) | HMO | $0 | $7,150 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 006 NM (HMO) | HMO | $0 | $8,000 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 006 OH (HMO) | HMO | $0 | $8,000 | $461 | $250 | $400 | |
| DEVOTED GIVEBACK 006 TX (HMO) | HMO | $0 | $8,300 | $461 | $250 | $400 | |
| DEVOTED GIVEBACK 007 WA (HMO) | HMO | $0 | $9,850 | $650 | $200 | ||
| DEVOTED GIVEBACK 008 TN (HMO) | HMO | $0 | $9,500 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 008 TX (HMO) | HMO | $0 | $8,650 | $461 | $2,500 | $400 | |
| DEVOTED GIVEBACK 009 OH (HMO) | HMO | $0 | $8,000 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 009 PA (HMO) | HMO | $0 | $8,000 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 009 VA (HMO) | HMO | $0 | $8,250 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 010 MO (HMO) | HMO | $0 | $7,150 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 011 PA (HMO) | HMO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 012 NC (HMO) | HMO | $0 | $9,850 | $461 | $500 | $200 | |
| DEVOTED GIVEBACK 012 OR (HMO) | HMO | $0 | $9,850 | $650 | $200 | ||
| DEVOTED GIVEBACK 012 VA (HMO) | HMO | $0 | $8,250 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 012 WA (HMO) | HMO | $0 | $9,850 | $650 | $200 | ||
| DEVOTED GIVEBACK 013 AZ (HMO) | HMO | $0 | $8,900 | $461 | $250 | $400 | |
| DEVOTED GIVEBACK 013 FL (HMO) | HMO | $0 | $7,150 | $650 | $1,500 | $350 | |
| DEVOTED GIVEBACK 013 PA (HMO) | HMO | $0 | $8,000 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 014 FL (HMO) | HMO | $0 | $7,150 | $650 | $1,250 | $350 | |
| DEVOTED GIVEBACK 015 CO (HMO) | HMO | $0 | $9,850 | $650 | $200 | ||
| DEVOTED GIVEBACK 015 FL (HMO) | HMO | $0 | $7,150 | $650 | $1,250 | $350 | |
| DEVOTED GIVEBACK 015 PA (HMO) | HMO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 018 FL (HMO) | HMO | $0 | $7,150 | $650 | $1,250 | $350 | |
| DEVOTED GIVEBACK 019 AZ (HMO) | HMO | $0 | $8,900 | $461 | $250 | $400 | |
| DEVOTED GIVEBACK 021 TX (HMO) | HMO | $0 | $9,850 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 022 MO (HMO) | HMO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED GIVEBACK 022 NC (HMO) | HMO | $0 | $9,300 | $650 | $250 | $200 | |
| DEVOTED GIVEBACK 024 NC (HMO) | HMO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED GIVEBACK 028 OR (HMO) | HMO | $0 | $8,900 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 030 NC (HMO) | HMO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED GIVEBACK 031 FL (HMO) | HMO | $0 | $7,750 | $650 | $1,250 | $350 | |
| DEVOTED GIVEBACK 032 FL (HMO) | HMO | $0 | $7,150 | $650 | $1,250 | $350 | |
| DEVOTED GIVEBACK 035 FL (HMO) | HMO | $0 | $7,150 | $650 | $1,250 | $350 | |
| DEVOTED GIVEBACK 035 IA (HMO) | HMO | $0 | $7,150 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 045 FL (HMO) | HMO | $0 | $7,700 | $650 | $1,250 | $350 | |
| DEVOTED GIVEBACK 048 TX (HMO) | HMO | $0 | $8,550 | $461 | $250 | $200 | |
| DEVOTED GIVEBACK 049 FL (HMO) | HMO | $0 | $7,150 | $650 | $1,250 | $350 | |
| DEVOTED GIVEBACK 051 FL (HMO) | HMO | $0 | $7,150 | $650 | $1,250 | $350 | |
| DEVOTED GIVEBACK 068 TX (HMO) | HMO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED GIVEBACK 074 TX (HMO) | HMO | $0 | $9,850 | $650 | $250 | $200 | |
| DEVOTED GIVEBACK 091 AZ (HMO) | HMO | $0 | $8,850 | $650 | $250 | $400 | |
| DEVOTED GIVEBACK 093 FL (HMO) | HMO | $0 | $7,150 | $650 | $250 | $200 | |
| DEVOTED GIVEBACK 095 AZ (HMO) | HMO | $0 | $8,850 | $650 | $250 | $400 | |
| DEVOTED GIVEBACK 099 AZ (HMO) | HMO | $0 | $9,450 | $650 | $250 | $400 | |
| DEVOTED GIVEBACK EXTRAS 008 HI (HMO) | HMO | $0 | $7,800 | $700 | $400 | ||
| DEVOTED GIVEBACK EXTRAS 008 IL (HMO) | HMO | $0 | $5,900 | $700 | $3,250 | $400 | |
| DEVOTED GIVEBACK EXTRAS 009 HI (HMO) | HMO | $0 | $7,700 | $700 | $400 | ||
| DEVOTED GIVEBACK EXTRAS 015 NM (HMO) | HMO | $0 | $5,850 | $700 | $3,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 016 NM (HMO) | HMO | $0 | $6,150 | $700 | $2,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 019 CO (HMO) | HMO | $0 | $6,750 | $700 | $400 | ||
| DEVOTED GIVEBACK EXTRAS 020 CO (HMO) | HMO | $0 | $7,000 | $700 | $400 | ||
| DEVOTED GIVEBACK EXTRAS 020 WA (HMO) | HMO | $0 | $8,100 | $700 | $400 | ||
| DEVOTED GIVEBACK EXTRAS 021 CO (HMO) | HMO | $0 | $8,400 | $700 | $350 | ||
| DEVOTED GIVEBACK EXTRAS 021 WA (HMO) | HMO | $0 | $8,200 | $700 | $250 | ||
| DEVOTED GIVEBACK EXTRAS 022 OR (HMO) | HMO | $0 | $7,950 | $700 | $400 | ||
| DEVOTED GIVEBACK EXTRAS 022 WA (HMO) | HMO | $0 | $8,300 | $700 | $400 | ||
| DEVOTED GIVEBACK EXTRAS 024 MO (HMO) | HMO | $0 | $7,300 | $700 | $4,000 | $350 | |
| DEVOTED GIVEBACK EXTRAS 024 OR (HMO) | HMO | $0 | $7,900 | $700 | $350 | ||
| DEVOTED GIVEBACK EXTRAS 025 MO (HMO) | HMO | $0 | $5,000 | $700 | $4,000 | $350 | |
| DEVOTED GIVEBACK EXTRAS 025 OR (HMO) | HMO | $0 | $7,700 | $700 | $400 | ||
| DEVOTED GIVEBACK EXTRAS 026 MO (HMO) | HMO | $0 | $5,200 | $700 | $3,250 | $350 | |
| DEVOTED GIVEBACK EXTRAS 026 OH (HMO) | HMO | $0 | $6,350 | $700 | $3,750 | $400 | |
| DEVOTED GIVEBACK EXTRAS 027 OH (HMO) | HMO | $0 | $6,400 | $700 | $3,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 028 MO (HMO) | HMO | $0 | $5,100 | $700 | $4,000 | $350 | |
| DEVOTED GIVEBACK EXTRAS 028 OH (HMO) | HMO | $0 | $6,800 | $700 | $3,000 | $300 | |
| DEVOTED GIVEBACK EXTRAS 029 OR (HMO) | HMO | $0 | $7,900 | $700 | $350 | ||
| DEVOTED GIVEBACK EXTRAS 029 VA (HMO) | HMO | $0 | $6,800 | $700 | $2,500 | $350 | |
| DEVOTED GIVEBACK EXTRAS 031 VA (HMO) | HMO | $0 | $6,800 | $700 | $3,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 032 PA (HMO) | HMO | $0 | $7,100 | $700 | $3,750 | $400 | |
| DEVOTED GIVEBACK EXTRAS 032 VA (HMO) | HMO | $0 | $6,800 | $700 | $3,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 033 PA (HMO) | HMO | $0 | $7,600 | $700 | $4,250 | $400 | |
| DEVOTED GIVEBACK EXTRAS 034 PA (HMO) | HMO | $0 | $6,850 | $700 | $3,750 | $400 | |
| DEVOTED GIVEBACK EXTRAS 035 PA (HMO) | HMO | $0 | $7,950 | $700 | $4,250 | $400 | |
| DEVOTED GIVEBACK EXTRAS 036 PA (HMO) | HMO | $0 | $8,400 | $700 | $3,000 | $250 | |
| DEVOTED GIVEBACK EXTRAS 038 NC (HMO) | HMO | $0 | $5,700 | $700 | $2,500 | $350 | |
| DEVOTED GIVEBACK EXTRAS 039 NC (HMO) | HMO | $0 | $7,050 | $700 | $4,250 | $350 | |
| DEVOTED GIVEBACK EXTRAS 041 NC (HMO) | HMO | $0 | $6,750 | $700 | $4,000 | $300 | |
| DEVOTED GIVEBACK EXTRAS 042 NC (HMO) | HMO | $0 | $7,100 | $700 | $4,000 | $350 | |
| DEVOTED GIVEBACK EXTRAS 044 NC (HMO) | HMO | $0 | $7,150 | $700 | $4,000 | $350 | |
| DEVOTED GIVEBACK EXTRAS 105 AZ (HMO) | HMO | $0 | $5,550 | $700 | $4,250 | $400 | |
| DEVOTED GIVEBACK EXTRAS 105 FL (HMO) | HMO | $0 | $5,550 | $700 | $3,750 | $400 | |
| DEVOTED GIVEBACK EXTRAS 106 AZ (HMO) | HMO | $0 | $7,850 | $700 | $2,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 106 FL (HMO) | HMO | $0 | $5,150 | $700 | $4,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 107 AZ (HMO) | HMO | $0 | $5,650 | $700 | $3,250 | $400 | |
| DEVOTED GIVEBACK EXTRAS 107 FL (HMO) | HMO | $0 | $5,800 | $700 | $2,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 108 FL (HMO) | HMO | $0 | $5,150 | $700 | $4,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 108 IA (HMO) | HMO | $0 | $5,900 | $700 | $3,250 | $400 | |
| DEVOTED GIVEBACK EXTRAS 109 FL (HMO) | HMO | $0 | $5,400 | $700 | $4,000 | $250 | |
| DEVOTED GIVEBACK EXTRAS 109 TX (HMO) | HMO | $0 | $6,700 | $700 | $3,750 | $250 | |
| DEVOTED GIVEBACK EXTRAS 110 FL (HMO) | HMO | $0 | $5,150 | $700 | $3,750 | $400 | |
| DEVOTED GIVEBACK EXTRAS 110 TX (HMO) | HMO | $0 | $7,150 | $700 | $4,000 | $250 | |
| DEVOTED GIVEBACK EXTRAS 112 FL (HMO) | HMO | $0 | $5,100 | $700 | $4,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 112 TX (HMO) | HMO | $0 | $7,350 | $700 | $3,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 113 FL (HMO) | HMO | $0 | $5,150 | $700 | $2,050 | $400 | |
| DEVOTED GIVEBACK EXTRAS 113 TX (HMO) | HMO | $0 | $5,700 | $700 | $3,000 | $400 | |
| DEVOTED GIVEBACK EXTRAS 114 FL (HMO) | HMO | $0 | $5,150 | $700 | $3,750 | $400 | |
| DEVOTED GIVEBACK EXTRAS 114 TX (HMO) | HMO | $0 | $5,600 | $700 | $3,250 | $400 | |
| DEVOTED GIVEBACK EXTRAS 115 FL (HMO) | HMO | $0 | $5,150 | $700 | $3,750 | $400 | |
| DEVOTED GIVEBACK EXTRAS 116 FL (HMO) | HMO | $0 | $5,700 | $700 | $3,750 | $400 | |
| DEVOTED GIVEBACK EXTRAS 116 TX (HMO) | HMO | $0 | $6,600 | $700 | $4,250 | $350 | |
| DEVOTED GIVEBACK EXTRAS 117 FL (HMO) | HMO | $0 | $5,150 | $700 | $3,750 | $400 | |
| DEVOTED MA ONLY 005 AZ (HMO) | HMO | $6,650 | $1,000 | $400 | |||
| DEVOTED MA ONLY 020 TX (HMO) | HMO | $9,250 | $1,000 | $400 | |||
| DEVOTED PREMIUM 002 OH (HMO) | HMO | $31 | $6,500 | $650 | $2,000 | $300 | |
| DEVOTED PREMIUM 002 TX (HMO) | HMO | $5 | $4,150 | $650 | $3,000 | $250 | |
| DEVOTED PREMIUM 004 TX (HMO) | HMO | $5 | $3,900 | $650 | $4,000 | $400 | |
| DEVOTED PREMIUM 005 OR (HMO) | HMO | $43 | $5,900 | $650 | $400 | ||
| DEVOTED PREMIUM 027 OR (HMO) | HMO | $48 | $5,900 | $650 | $1,500 | $400 | |
| DEVOTED PREMIUM 044 FL (HMO) | HMO | $7.30 | $3,900 | $650 | $1,500 | $150 |
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