Table of Evidence of Coverage (EOC) and Coverage Determination

Freedom Savings Plan (HMO)
Plan Type: MA
Plan Number: 052

Freedom Medicare Plan RX (HMO)
Plan Type: MAPD
Plan Number: 059

Freedom Medicare Plan RX (HMO)
Plan Type: MAPD
Plan Number: 060

Freedom VIP Care (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 070

Freedom VIP Savings (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 072

Freedom VIP Savings COPD (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 077

Freedom Medi-Medi Partial (HMO D-SNP)
Plan Type: Dual Special Needs Plan
Plan Number: 078

Freedom VIP Savings (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 082

Freedom VIP Savings COPD (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 083

Freedom Medi-Medi Full (HMO D-SNP)
Plan Type: Dual Special Needs Plan
Plan Number: 087

Freedom Platinum Plan RX (HMO)
Plan Type: MAPD
Plan Number: 088

Freedom Platinum Plan RX (HMO)
Plan Type: MAPD
Plan Number: 089

Freedom Platinum Plan RX (HMO)
Plan Type: MAPD
Plan Number: 091

Freedom Platinum Plan RX (HMO)
Plan Type: MAPD
Plan Number: 092

Freedom Platinum Plan RX (HMO)
Plan Type: MAPD
Plan Number: 093

Freedom Platinum Plan RX (HMO)
Plan Type: MAPD
Plan Number: 094

Freedom Platinum Rewards Plan RX (HMO)
Plan Type: MAPD
Plan Number: 096

Freedom Platinum Plan RX (HMO)
Plan Type: MAPD
Plan Number: 098

Freedom VIP Rewards (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 099

Freedom Platinum Rewards Plan RX (HMO)
Plan Type: MAPD
Plan Number: 102

Freedom Platinum Rewards Plan RX (HMO)
Plan Type: MAPD
Plan Number: 103

Freedom Platinum Plus Plan Rx (HMO)
Plan Type: MAPD
Plan Number: 104

Freedom Platinum Rewards Plan Rx (HMO)
Plan Type: MAPD
Plan Number: 105

Freedom Platinum Rewards Plan Rx
(HMO)
Plan Type: MAPD
Plan Number: 106

Freedom Platinum Rewards Plan Rx
(HMO)
Plan Type: MAPD
Plan Number: 107

Freedom VIP Rewards (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 108

Freedom Platinum Plus Plan Rx (HMO)
Plan Type: MAPD
Plan Number: 109

Freedom Platinum Plus Plan Rx (HMO)
Plan Type: MAPD
Plan Number: 110

Freedom Platinum Plus Plan Rx (HMO)
Plan Type: MAPD
Plan Number: 111