Table of Evidence of Coverage (EOC) and Coverage Determination

Optimum Gold Rewards Plan (HMO)
Plan Type: MAPD
Plan Number: 001

Optimum Platinum Plan (HMO)
Plan Type: MAPD
Plan Number: 002

Optimum Emerald Partial (HMO D-SNP)
Plan Type: Dual Special Needs Plan
Plan Number: 016

Optimum Emerald Full (HMO D-SNP)
Plan Type: Dual Special Needs Plan
Plan Number: 017

Optimum Gold Plan (HMO)
Plan Type: MAPD
Plan Number: 019

Optimum Gold Rewards Plan (HMO)
Plan Type: MAPD
Plan Number: 022

Optimum Gold Rewards Plan (HMO)
Plan Type: MAPD
Plan Number: 026

Optimum Diamond Rewards (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 028

Optimum Diamond Rewards COPD (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan number: 029

Optimum Diamond Savings (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 030

Optimum Diamond Savings COPD (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 031

Optimum Gold Plus Plan (HMO)
Plan Type: MAPD
Plan Number: 032

Optimum Diamond Rewards (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 034

Optimum Diamond Rewards COPD (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 035

Optimum Diamond (HMO C-SNP)
Plan Type: Chronic Special Needs Plans
Plan Number: 036