Alabama (Regional Office: Atlanta)

Part A -

Blue Cross and Blue Shield of Alabama
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Alabama

Alaska (Regional Office: Seattle)

Part A -

Premera Blue Cross
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

American Samoa

Part A -

Blue Cross Blue Shield United of Wisconsin
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Arizona (Regional Office: San Francisco)

Part A -

Blue Cross and Blue Shield of Arizona
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Arkansas (Regional Office: Dallas)

Part A -

Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company
Mutual of Omaha Insurance Company

Part B -

Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company

California (Regional Office: San Francisco)

Part A -

Blue Cross Blue Shield United of Wisconsin
Mutual of Omaha Insurance Company

Part B -

National Heritage Insurance Company

Colorado (Regional Office: Denver)

Part A -

TrailBlazer Health Enterprises, LLC
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Connecticut (Regional Office: Boston)

Part A -

Empire HealthChoice, Inc.
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Florida, Inc. (First Coast Service Options)

Delaware (Regional Office: Philadelphia)

Part A -

Empire HealthChoice, Inc.
Mutual of Omaha Insurance Company

Part B -

TrailBlazer Health Enterprises, LLC

District of Columbia (Regional Office: Philadelphia)

Part A -

Care First of Maryland, Inc.
Mutual of Omaha Insurance Company

Part B -

TrailBlazer Health Enterprises, LLC

Georgia (Regional Office: Atlanta)

Part A -

Blue Cross and Blue Shield of Georgia, Inc.
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Alabama

Guam (Regional Office: San Francisco)

Part A -

Blue Cross Blue Shield United of Wisconsin
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Hawaii (Regional Office: San Francisco)

Part A -

Blue Cross Blue Shield United of Wisconsin
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Idaho (Regional Office: Seattle)

Part A -

Regence Blue Cross Blue Shield of Oregon
Mutual of Omaha Insurance Company

Part B -

Connecticut General Life Insurance Company

Illinois (Regional Office: Chicago)

Part A -

Anthem Insurance Companies, Inc.
Mutual of Omaha Insurance Company

Part B -

Wisconsin Physicians Service

Indiana (Regional Office: Chicago)

Part A -

Anthem Insurance Companies, Inc.
Mutual of Omaha Insurance Company

Part B -

AdminaStar Federal, Inc.

Iowa (Regional Office: Kansas City)

Part A -

Blue Cross and Blue Shield of Alabama
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Kansas (Regional Office: Kansas City)

Part A -

Blue Cross and Blue Shield of Kansas, Inc.
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Kansas, Inc.

Kentucky (Regional Office: Atlanta)

Part A -

Anthem Insurance Companies, Inc.
Mutual of Omaha Insurance Company

Part B -

AdminaStar Federal, Inc.

Louisiana (Regional Office: Dallas)

Part A -

Blue Cross and Blue Shield of Mississippi
Mutual of Omaha Insurance Company

Part B -

Arkansas Blue Cross and Blue Shield

Maine (Regional Office: Boston)

Part A -

Associated Hospital Service of Maine
Mutual of Omaha Insurance Company

Part B -

National Heritage Insurance Company

Maryland (Regional Office: Philadelphia)

Part A -

Care First of Maryland, Inc.
Mutual of Omaha Insurance Company

Part B -

TrailBlazer Health Enterprises, LLC

Massachusetts (Regional Office: Boston)

Part A -

Associated Hospital Service of Maine
Mutual of Omaha Insurance Company

Part B -

National Heritage Insurance Company

Michigan (Regional Office: Chicago)

Part A -

Blue Cross Blue Shield United of Wisconsin
United Health Care Insurance Company
Mutual of Omaha Insurance Company

Part B -

Wisconsin Physicians Service

Minnesota (Regional Office: Chicago)

Part A -

Noridian Mutual Insurance Company
Mutual of Omaha Insurance Company

Part B -

Wisconsin Physicians Service

Mississippi (Regional Office: Atlanta)

Part A -

Blue Cross and Blue Shield of Mississippi
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Alabama

Missouri (Regional Office: Kansas City)

Part A -

Blue Cross and Blue Shield of Mississippi
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Kansas, Inc. (Western Missouri)
Arkansas Blue Cross Blue Shield (Eastern Missouri)

Montana (Regional Office: Denver)

Part A -

Blue Cross and Blue Shield of Montana, Inc.
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Montana, Inc.

Nebraska (Regional Office: Kansas City)

Part A -

Blue Cross and Blue Shield of Nebraska
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Kansas, Inc.

Nevada (Regional Office: San Francisco)

Part A -

Blue Cross Blue Shield United of Wisconsin
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

New Hampshire (Regional Office: Boston/San Francisco)

Part A -

New Hampshire-Vermont Health Service
Mutual of Omaha Insurance Company

Part B -

National Heritage Insurance Company

New Jersey (Regional Office: New York)

Part A -

Blue Cross Blue Shield of Tennessee
Mutual of Omaha Insurance Company

Part B -

Empire HealthChoice, Inc.

New Mexico (Regional Office: Dallas)

Part A -

TrailBlazer Health Enterprises, LLC
Mutual of Omaha Insurance Company

Part B -

Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company

New York (Regional Office: New York)

Part A -

Empire HealthChoice, Inc.
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Western New York
Empire HealthChoice, Inc.
Group Health Incorporated

North Carolina (Regional Office: Atlanta)

Part A -

Blue Cross and Blue Shield of North Carolina
Mutual of Omaha Insurance Company

Part B -

Connecticut General Life Insurance Company

North Dakota (Regional Office: Denver)

Part A -

Noridian Mutual Insurance Company
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Northern Marianna Islands (Regional Office: San Francisco)

Part A -

Blue Cross Blue Shield United of Wisconsin
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Ohio (Regional Office: Chicago)

Part A -

Anthem Insurance Companies, Inc.
Mutual of Omaha Insurance Company

Part B -

Nationwide Mutual Insurance Company

Oklahoma (Regional Office: Dallas)

Part A -

Chisolm Administrative Services
Mutual of Omaha Insurance Company

Part B -

Arkansas Blue Cross and Blue Shield, A Mutual Insurance Company

Oregon (Regional Office: Seattle)

Part A -

Blue Cross and Blue Shield of Oregon
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Pennsylvania (Regional Office: Philadelphia)

Part A -

Highmark, Inc.
Mutual of Omaha Insurance Company

Part B -

Highmark, Inc.

Puerto Rico (Regional Office: New York)

Part A -

Cooperative de Seguros de Vida de Puerto Rico
Mutual of Omaha Insurance Company

Part B -

Triple-S, Inc.

Rhode Island (Regional Office: Boston)

Part A -

Blue Cross and Blue Shield of Rhode Island
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Rhode Island

South Carolina (Regional Office: Atlanta)

Part A -

Blue Cross and Blue Shield of South Carolina
Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of South Carolina

South Dakota (Regional Office: Denver)

Part A -

Blue Cross and Blue Shield of Alabama
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

Tennessee (Regional Office: Atlanta)

Part A -

Blue Cross and Blue Shield of Tennessee
Mutual of Omaha Insurance Company

Part B -

Connecticut General Life Insurance Company

Texas (Regional Office: Dallas)

Part A -

TrailBlazer Health Enterprises, LLC
Mutual of Omaha Insurance Company

Part B -

TrailBlazer Health Enterprises, LLC

U.S. Virgin Islands (Regional Office: New York)

Part A -

Cooperative de Seguros de Vida de Puerto Rico
Mutual of Omaha Insurance Company

Part B -

Triple-S, Inc.

Utah (Regional Office: Denver)

Part A -

Regence Blue Cross Blue Shield of Oregon; Mutual of Omaha Insurance Company

Part B -

Blue Cross and Blue Shield of Utah

Vermont (Regional Office: Boston/San Francisco)

Part A -

New Hampshire-Vermont Health Service
Mutual of Omaha Insurance Company

Part B -

National Heritage Insurance Company

Virginia (Regional Office: Philadelphia)

Part A -

Blue Cross Blue Shield United of Wisconsin
Mutual of Omaha Insurance Company

Part B -

TrailBlazer Health Enterprises, LLC

Washington (Regional Office: Seattle)

Part A -

Premera Blue Cross Blue Shield
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company

West Virginia (Regional Office: Philadelphia)

Part A -

Blue Cross Blue Shield United of Wisconsin
Mutual of Omaha Insurance Company

Part B -

Nationwide Mutual Insurance Company

Wisconsin (Regional Office: Chicago)

Part A -

Blue Cross and Blue Shield United of Wisconsin
Mutual of Omaha Insurance Company

Part B -

Wisconsin Physicians Service Insurance Corporation

Wyoming (Regional Office: Denver)

Part A -

Blue Cross and Blue Shield of Wyoming
Mutual of Omaha Insurance Company

Part B -

Noridian Mutual Insurance Company