HUMUNA 2016 AND BENEFIT NUMBERS AGENT USE ONLY NAME STATE SERVICE AREA BSN PREM IOWA ENHANCED S5884-083-000 PDP ND SD MT WY PDP 235408 026 $61.00 IOWA PREFERRED S5884-145-000 PDP ND SD MT WY PDP 235408 025 $27.40 IOWA WALMART S5884-171-000 PDP ND SD MT WY PDP 235408 027 $18.40 WISCONSIN ENHANCED S5884-074-000 PDP WI WI PDP 235455 026 $66.90 WISCONSIN PREFERRED S5884-139-000 PDP WI WI PDP 235455 025 $34.50 WISCONSIN WALMART S5884-162-000 PDP WI WI PDP 235455 027 $18.40 NAME STATE SERVICE AREA MINNESOTA GC H8145-089-000 PFFS MINNESOTA HC H6609-142-001 LPPO Blue Earth, Brown, Dodge, Faribault, Fillmore, Freeborn, Goodhue, Houston, Jackson, Martin, Mower, Nicollet, Olmsted, PFFS 250918 001 000 MAPD $97.00 Redwood, Rice, Sibley, Steele, Wabasha, Waseca, Winona Aitkin, Anoka, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Cottonwood, Crow Wing, Dakota, Douglas, Faribault, Goodhue, Grant, Hennepin, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Lac qui Parle, Lake, Lincoln, Lyon, McLeod, Martin, Meeker, LPPO 294086 001 000 Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Otter Tail, Pine, Pipestone, Pope, Ramsey, Redwood, Renville, Rice, Rock, Scott, Sherburne, Sibley, St. Louis, Stearns, Swift, Todd, Wadena, Waseca, Washington, Watonwan, Wilkin, Wright Hubbard, Kittson, Lake of the Woods, Le LPPO 294091 001 000 Sueur, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake, Roseau LPPO 294096 001 000 Aitkin, Anoka, Benton, Carlton, Carver, Cass, Chisago, Crow Wing, Dakota, Douglas, Hennepin, Isanti, Itasca, Kanabec, Lake, McLeod, Meeker, Mille Lacs, Morrison, Otter Tail, Pine, Ramsey, LPPO 247178 008 001 MAPD $69.00 Redwood, Scott, Sherburne, St. Louis, Stearns, Todd, Wadena, Washington, Wilkin, Wright
MINNESOTA HC H6609-142-001 LPPO MINNESOTA HC H6609-142-002 LPPO MINNESOTA HC H6609-142-002 LPPO Hubbard, Lake of the Woods, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake, Roseau Blue Earth, Brown, Cottonwood, Faribault, Goodhue, Jackson, Martin, Mower, Nicollet, Rice, Sibley, Waseca, Watonwan LPPO 256150 007 001 MAPD $69.00 LPPO 247178 009 002 MAPD $71.00 LPPO 251006 007 002 MAPD $71.00 MINNESOTA HC H6609-142-002 LPPO Le Sueur LPPO 256150 004 002 MAPD $71.00 Aitkin, Anoka, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Cottonwood, Crow Wing, Dakota, Douglas, Faribault, Goodhue, Grant, Hennepin, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Lac qui Parle, Lake, Lincoln, Lyon, McLeod, Martin, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Otter Tail, Pine, Pipestone, Pope, Ramsey, Redwood, Renville, Rice, Rock, Scott, Sherburne, Sibley, St. Louis, Stearns, Swift, Todd, Wadena, Waseca, Washington, Watonwan, Wilkin, Wright LPPO 247178 007 000 MAPD $27.50 LPPO 251006 008 000 MAPD $27.50 Hubbard, Kittson, Lake of the Woods, Le LPPO 256150 005 000 MAPD $27.50 Sueur, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake, Roseau IOWA CHA GP H0028-001-000 HMO Clinton, Delaware, Iowa, Johnson, Jones, HMO 256079 001 000 MAPD $0.00 Linn, Muscatine, Scott, Washington IOWA CHA GP H0028-001-000 HMO Lyon, Plymouth, Sioux, Woodbury HMO 294481 001 000 MAPD $0.00
IOWA GP H0028-001-000 HMO Mills, Montgomery, Pottawattamie HMO 255968 002 000 MAPD $0.00 Boone, Dallas, Jasper, Madison, Marion, IOWA GP H0028-001-000 HMO Marshall, Story, Warren HMO 256088 002 000 MAPD $0.00 IOWA GP H0028-001-000 HMO Polk HMO 290667 002 000 MAPD $0.00 IOWA HC H1418-008-000 LPPO Scott LPPO 245265 010 000 MAPD $51.00 IOWA HC H6609-003-000 LPPO Pottawattamie LPPO 290976 001 000 MAPD $109.00 Pottawattamie LPPO 290751 001 000 Adair, Allamakee, Appanoose, Audubon, Butler, Calhoun, Carroll, Cass, Cerro Gordo, Cherokee, Clayton, Crawford, Davis, Decatur, Dickinson, Emmet, Floyd, Franklin, Fremont, Grundy, Hamilton, Hancock, Hardin, Henry, Humboldt, Ida, Jackson, Jefferson, Kossuth, Lee, Lucas, Lyon, Mahaska, Mills, Monona, Monroe, O'Brien, Osceola, Page, Palo Alto, Plymouth, Pocahontas, Polk, Poweshiek, Ringgold, Sac, Sioux, Tama, Union, Van Buren, Wapello, Wayne, Webster, Winnebago, Winneshiek, Woodbury, Worth, Wright LPPO 294090 001 000 Boone, Buena Vista, Dallas, Harrison, Jasper, Keokuk, Madison, Marion, Marshall, LPPO 294093 001 000 Story, Warren Clinton, Delaware, Iowa, Johnson, Jones, LPPO 294094 001 000 Linn, Muscatine Washington LPPO 294095 001 000 Boone, Dallas, Jasper, Madison, Marion, IOWA HC H6609-138-000 LPPO LPPO 290806 001 000 MAPD $51.00 Marshall, Story, Warren IOWA HC H6609-138-000 LPPO Delaware, Iowa, Johnson, Jones, Linn, LPPO 290809 001 000 MAPD $51.00 Muscatine, Polk IOWA HC H6609-138-000 LPPO Washington LPPO 290810 001 000 MAPD $51.00
IOWA HC H6609-140-000 LPPO Adair, Allamakee, Appanoose, Audubon, Butler, Calhoun, Carroll, Cass, Cerro Gordo, Cherokee, Clayton, Crawford, Davis, Decatur, Dickinson, Emmet, Floyd, Franklin, Fremont, Grundy, Hamilton, Hancock, Hardin, Henry, Humboldt, Ida, Jackson, Jefferson, Kossuth, Lee, Lucas, Lyon, LPPO 290902 001 000 MAPD $63.00 Mahaska, Mills, Monona, Monroe, O'Brien, Osceola, Page, Palo Alto, Plymouth, Pocahontas, Poweshiek, Ringgold, Sac, Sioux, Tama, Union, Van Buren, Wapello, Wayne, Webster, Winnebago, Winneshiek, Woodbury, Worth, Wright IOWA HC H6609-140-000 LPPO Buena Vista, Harrison, Keokuk LPPO 290930 001 000 MAPD $63.00 IOWA HC H6609-140-000 LPPO Clinton LPPO 290933 001 000 MAPD $63.00 IOWA GC H8145-089-000 PFFS Adair, Adams, Audubon, Buena Vista, Calhoun, Carroll, Cherokee, Dickinson, Emmet, Harrison, Humboldt, Ida, Louisa, Lyon, Madison, Pocahontas, Sac, Sioux, Union, Van Buren, Washington, Webster PFFS 253810 003 000 MAPD $97.00 IOWA GC H8145-155-000 PFFS Adair, Adams, Audubon, Buena Vista, Calhoun, Carroll, Cherokee, Dickinson, Emmet, Harrison, Humboldt, Ida, Louisa, Lyon, Madison, Pocahontas, Sac, Sioux, Union, Van Buren, Washington, Webster PFFS 253810 002 000 Brown, Calumet, Fond du Lac, Green Lake, WISCONSIN GP H6622-001-000 HMO WI Manitowoc, Marathon, Marquette, Oconto, HMO 256270 001 000 MAPD $0.00 Outagamie, Shawano, Waupaca, Milwaukee, Ozaukee, Racine, Sheboygan, WISCONSIN GP H6622-002-000 HMO WI HMO 256272 001 000 MAPD $31.00 Washington, Waukesha Dodge, Kenosha, Milwaukee, Ozaukee, WISCONSIN HC H5216-001-000 LPPO WI Racine, Washington, Waukesha LPPO 234820 003 000 MAPD $91.00 Brown, Calumet, Door, Fond du Lac, Forest, Green Lake, Kewaunee, Manitowoc, Marathon, Marinette, Marquette, WISCONSIN HC H5216-003-000 LPPO WI LPPO 243087 001 000 MAPD $81.00 Menominee, Oconto, Outagamie, Portage, Sheboygan, Waupaca, Waushara, Winnebago Columbia, Crawford, Dane, Green, Iowa, WISCONSIN HC H5216-006-000 LPPO WI LPPO 247142 001 000 MAPD $61.00 Jefferson, Lafayette, Richland, Rock, Sauk WISCONSIN HC R5826-009-000 RPPO WI State Wide RPPO 235454 010 000 MAPD $127.00
WISCONSIN HC R5826-023-000 RPPO WI State Wide RPPO 235454 001 000 Adams, Barron, Brown, Burnett, Calumet, Clark, Dane, Dodge, Dunn, Eau Claire, Fond du Lac, Forest, Green Lake, Jackson, Jefferson, Juneau, Kenosha, La Crosse, Lafayette, Langlade, Lincoln, Manitowoc, Marathon, Marquette, Menominee, WISCONSIN GC H8145-006-000 PFFS WI PFFS 250947 002 000 MAPD $99.00 Milwaukee, Oneida, Outagamie, Ozaukee, Pepin, Portage, Racine, Richland, Rusk, Sauk, Shawano, Sheboygan, Taylor, Trempealeau, Vernon, Vilas, Walworth, Washburn, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood SOUTH DAKOTA CHA GP H0028-001-000 HMO SD Lincoln, Union HMO 294482 001 000 MAPD $0.00 Butte, Custer, Fall River, Lawrence, Meade, SOUTH DAKOTA HC H6609-001-000 LPPO SD LPPO 247067 001 000 MAPD $69.00 Pennington Beadle, Bon Homme, Brookings, Brown, Butte, Clark, Clay, Codington, Custer, Davison, Day, Deuel, Fall River, Grant, Hamlin, Hanson, Hutchinson, Kingsbury, SOUTH DAKOTA HC H6609-004-000 LPPO SD LPPO 247067 005 000 Lake, Lawrence, Lincoln, McCook, Marshall, Meade, Miner, Minnehaha, Moody, Pennington, Roberts, Sanborn, Spink, Turner, Union, Yankton Beadle, Bon Homme, Brookings, Brown, Clark, Clay, Codington, Davison, Day, Deuel, Grant, Hamlin, Hanson, Hutchinson, SOUTH DAKOTA HC H6609-019-000 LPPO SD Kingsbury, Lake, Lincoln, McCook, Marshall, Miner, Minnehaha, Moody, Roberts, Sanborn, Spink, Turner, Union, Yankton Bennett, Bon Homme, Brule, Campbell, Codington, Corson, Davison, Deuel, Dewey, Edmunds, Faulk, Haakon, Hanson, Hughes, LPPO 247067 003 000 MAPD $57.00 SOUTH DAKOTA GC H8145-089-000 PFFS SD Hyde, Jones, Lyman, McPherson, Mellette, PFFS 290654 001 000 MAPD $97.00 Pennington, Perkins, Potter, Shannon, Spink, Stanley, Sully, Tripp, Turner, Union, Walworth, Yankton Barnes, Burleigh, Cass, Grand Forks, NORTH DAKOTA HC H6609-004-000 LPPO ND LPPO 251046 004 000 Kidder, Morton, Richland, Stutsman, Traill Barnes, Burleigh, Cass, Grand Forks, NORTH DAKOTA HC H6609-017-000 LPPO ND LPPO 251046 003 000 MAPD $71.00 Kidder, Morton, Richland, Stutsman, Traill NORTH DAKOTA GC H8145-089-000 PFFS ND Burleigh PFFS 290668 001 000 MAPD $97.00