IMPORTANT INFORMATION REGARDING Workers Compensation Texas Quarterly Client Listing

Transcription

1 April 11, 2018 IMPORTANT INFORMATION REGARDING Workers Compensation Texas Quarterly Client Listing Dear Pharmacy Provider: In accordance with Texas Labor Code , OptumRx on behalf of itself and each of its affiliate(s) that provides pharmacy benefit management services (including but not limited to Catamaran LLC, Healthcare Solutions, Inc. (collectively, OptumRx ) is providing the following notification to providers in the State of Texas. In an effort to comply with this Texas law, we are attaching a listing of clients and their contact information who may access our pharmacy network. OptumRx Phone Numbers: No action is required on your part. If you have any questions regarding this communication, contract status, or other pharmacy related issues please contact OptumRx Pharmacy Network Relations at (877) option 2 (Monday Friday 8 AM 5 PM CT) or your questions to provider.relations@optum.com. All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. This document contains information that is considered proprietary to OptumRx and should not be reproduced without express written consent of OptumRx Optum, Inc. All rights reserved.

2 PBM: TechHealth Riveredge Drive, Suite 400 Tampa, FL TX Carrier Listing 1st Qtr 2018 Network: Optum RX 1600 McConnor Parkway Schaumbug, IL Main Phone (Direct, TPA, Other) (TPA name, if not direct) (Carrier) Street City State ZipCode Start Date End Date Allied Property & Casualty Insurance Co. Direct Locust St. Des Moines IA /1/2011 undetermined Dept AMCO Insurance Co. Direct Locust St. Des Moines IA /1/2011 undetermined Dept Depositors Insurance Co. Direct Locust St. Des Moines IA /1/2011 undetermined Dept Nationwide Agribusiness Insurance Co. Direct Locust St. Dept Des Moines IA /1/2011 undetermined Nationwide Mutual Direct One Nationwide Columbus OH /1/2011 undetermined Plaza Nationwide Mutual Fire Direct One Nationwide Columbus OH /1/2011 undetermined Plaza Nationwide Property & Casualty Direct One Nationwide Plaza Columbus OH /1/2011 undetermined For more information regarding pharmacy informal networks click on the link: bin/broker.exe?_service=wcext&_program=progext.pharm_networkrpt.sas 4/4/ of 1

3 PBM: Equian 7480 Halcyon Point Dr., Suite 300 Montgomery, AL Main Phone (TPA name, if not direct) (Direct, TPA, Other) (Carrier) Street City State ZipCode Start Date End Date ACE AMERICAN INSURANCE COMPANY TPA Cottingham Butler Claims Services P O Box 1000 Philadelphia PA /8/2014 indefinite AMERICAN ZURICH INSURANCE COMPANY TPA Creative Risk Solutions Zurich Way Schaumburg IL /31/2006 indefinite AMERICAN ZURICH INSURANCE COMPANY TPA Cottingham Butler Claims Services Zurich Way Schaumburg IL /17/2007 indefinite ARCH INSURANCE COMPANY TPA Cottingham Butler Claims Services Plaza 3 3rd Floor Jersey City NJ /1/2014 indefinite CONTINENTAL CASUALTY COMPANY TPA Cottingham Butler Claims Services South Wabash Chicago IL /1/2002 indefinite DALLAS NATIONAL INSURANCE COMPANY TPA Cottingham Butler Claims Services North King St Ste 602 Wilmington DE /22/2011 indefinite DISCOVER PROPERTY & CASUALTY INSURANCE COMPANY TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite DISCOVERY MANAGERS, LLC TPA Creative Risk Solutions Batterson Park Rd Fl 3 Farmington CT /1/2013 indefinite FARMINGTON CASUALTY COMPANY TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite FIDELITY & GUARANTY INSURANCE COMPANY TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite GREAT MIDWEST INSURANCE COMPANY TPA Cottingham Butler Claims Services Gessner Road Suite 600 Houston TX /25/2016 indefinite GREAT WEST CASUALTY COMPANY TPA Cottingham Butler Claims Services W 29th St South Sioux City NE /1/2013 indefinite HARTFORD CASUALTY INSURANCE COMPANY TPA Creative Risk Solutions One Hartford Plaza T Hartford CT /1/2003 indefinite HARTFORD CASUALTY INSURANCE COMPANY TPA Cottingham Butler Claims Services One Hartford Plaza T Hartford CT /31/2003 indefinite HARTFORD FIRE INSURANCE COMPAY TPA Creative Risk Solutions One Hartford Plaza T Hartford CT /1/2003 indefinite HARTFORD UNDERWRITERS INSURANCE COMPANY TPA Creative Risk Solutions One Hartford Plaza T Hartford CT /1/2003 indefinite HARTFORD UNDERWRITERS INSURANCE COMPANY TPA Cottingham Butler Claims Services One Hartford Plaza T Hartford CT /31/2003 indefinite IMPERIUM INSURANCE COMPANY TPA Cottingham Butler Claims Services Gessner Road Suite 600 Houston TX /25/2016 indefinite INDEMNITY INSURANCE COMPANY OF NORTH AMERICA TPA Cottingham Butler Claims Services Walnut Street Philadelphia PA /1/2013 indefinite NEW HAMPSHIRE INSURANCE COMPANY TPA Cottingham Butler Claims Services Water Street 18th Floor New York City NY /1/2008 indefinite OLD REPUBLIC INSURANCE COMPANY TPA Cottingham Butler Claims Services P O Box 789 Greensburg PA /15/2015 indefinite PHOENIX INSURANCE COMPANY TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite SPARTA INSURANCE COMPANY TPA Cottingham Butler Claims Services Batterson Park Rd Fl 3 Farmington CT /27/2009 indefinite STANDARD FIRE INSURANCE COMPANY TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite SUSSEX INSURANCE COMPANY TPA Cottingham Butler Claims Services Po Box Columbia SC /22/2011 indefinite TRAVELERS CASUALTY AND SURETY COMPANY TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite TRAVELERS INDEMNITY COMPANY TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite TRAVELERS INDEMNITY COMPANY OF AMERICA TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite TRAVELERS INDEMNITY COMPANY OF CONNECTICUT TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA TPA Cottingham Butler Claims Services Tower Square Hartford CT /1/2003 indefinite TWIN CITY FIRE INSURANCE COMPANY TPA Creative Risk Solutions One Hartford Plaza T Hartford CT /1/2003 indefinite TWIN CITY FIRE INSURANCE COMPANY TPA Cottingham Butler Claims Services One Hartford Plaza T Hartford CT /31/2003 indefinite XL INSURANCE AMERICA TPA Cottingham Butler Claims Services Seaview Avenue Stamford CT /31/2014 indefinite XL SPECIALTY INSURANCE COMPANY TPA Cottingham Butler Claims Services Seaview Avenue Stamford CT /31/2014 indefinite ZURICH AMERICAN INSURANCE COMPANY TPA Creative Risk Solutions American Lane Tower 1 Floor 18 Schaumburg IL /31/2006 indefinite ZURICH AMERICAN INSURANCE COMPANY TPA Cottingham Butler Claims Services American Lane Tower 1 Floor 18 Schaumburg IL /17/2007 indefinite 4/4/ of 1

4 PBM: Healthcare Solutions, Inc Meadow Church Rd., Suite 300 Duluth, GA (Direct, TPA, Other) (TPA name, if not direct) ACE American Insurance Co. TPA FA Richards Walnut Street Philadelphia PA /06/03 Indefinite Alief ISD TPA JI Specialty High Star Houston TX /01/09 Indefinite One Liberty Plaza American Guarantee & Liability Comp TPA Zurich Services Broadway New York NY /19/02 Indefinite American Home Assurance Company TPA FA Richards PO Box Carrollton TX /06/03 Indefinite American Zurich Insurance Company TPA FA Richards PO Box Austin TX /06/03 Indefinite American Zurich Insurance Company TPA Zurich Services American Lane Schaumburg IL /19/02 Indefinite Amerisure Insurance Company Direct Contract Halsted Rd Farmington Hills MI /11/03 Indefinite Amerisure Mutual Insurance Company Direct Contract Halsted Rd Farmington Hills MI /11/03 Indefinite Amerisure Partners Insurance Co. Direct Contract Halsted Rd Farmington Hills MI /11/03 Indefinite Arch Insurance Company TPA FA Richards Halsted Rd Austin TX /06/03 Indefinite Argonaut Bill Audit/Review Co. Genex Chestnut St. Philadelphia PA /26/07 Indefinite One Liberty Plaza Assurance Company of America TPA Zurich Services Broadway New York NY /19/02 Indefinite Beaumont Independent School District TPA FA Richards Harrison St. Beaumont TX /06/03 Indefinite Berkley National Insurance Co. Direct Contract Berkshire Hathaway Homestate Insurance Bill Audit/Review Co. Genex Brownsville Public Utilities TPA FA Richards PO Box 3270 Brownsville TX /06/03 Indefinite 101 North Texas Bryan ISD TPA JI Specialty Avenue Bryan TX /01/09 Indefinite Carolina Casualty Insurance Company TPA FA Richards Touchton Rd East Jacksonville FL /06/03 Indefinite Carrollton Farmers Branch ISD TPA FA Richards N Perry Road Carrollton TX /01/06 Indefinite Church Mutual Insurance Company Direct Contract PO Box 342 Merrill WI /05/01 Indefinite CIGNA Bill Audit/Review Co. Genex Chestnut St. Philadelphia PA /26/07 Indefinite City of Austin TPA JI Specialty TX Cntr, 505 Barton Springs Rd Austin TX /01/06 Indefinite City of Baytown TPA AS&G Claims City of Beaumont TPA AS&G Claims City of Bryan TPA Argus Services City of College Station TPA Argus Services City of Corpus Christi TPA FA Richards Leopard Dept. of Risk Mgmt Corpus Christi TX /06/03 Indefinite City of Dallas Direct Contract Marilla St. Dallas TX /17/10 Indefinite Clarendon National Insurance Co. TPA FA Richards Avenue of the Americas New York NY /06/03 Indefinite Colonial American Casualty Ins Comp TPA Zurich Services Red Brook Blvd Owings Mills MD /19/02 Indefinite Companion Property & Casualty Insur. TPA FA Richards PO Box Austin TX /06/03 Indefinite Douglas Continental Western Insurance Co Bill Audit/Review Co. Genex Avenue Urbandale IA /23/14 Indefinite Continental Western Insurance Co Direct Contract Douglas Avenue Urbandale IA /23/14 Indefinite 4/4/ of 4

5 PBM: Healthcare Solutions, Inc Meadow Church Rd., Suite 300 Duluth, GA (Direct, TPA, Other) (TPA name, if not direct) Crowley ISD TPA JI Specialty Hwy Crowley TX /01/07 Indefinite 4100 Midway Road, Deep East Texas Self Insurance Fund Bill Audit/Review Co. Injury Management Suite 1145 Carrollton TX /07/07 Indefinite Dickinson ISD TPA JI Specialty FM 517 East Dickinson TX /01/09 Indefinite 1501 South MoPac Discover Property & Casualty Insurance TPA FA Richards Expwy. Austin TX /06/03 Indefinite Discover Property and Casualty Ins TPA JI Specialty Boyer Blvd, Suite 100 Austin TX /01/06 Indefinite EMCASCO Insurance Company Direct Contract PO Box Richardson TX /03/06 Indefinite Employers Mutual Casualty Co Direct Contract PO Box Richardson TX /03/06 Indefinite Employers Reinsurance Corp. merged Westport TPA FA Richards PO Box Austin TX /06/03 Indefinite 314 East Highland Everest National Insurance Company TPA FA Richards Mall Blvd. Austin TX /06/03 Indefinite Federal Insurance Company TPA FA Richards Wild Basin Rd Ste 207 Austin TX /06/03 Indefinite Fedex Freight Inc. Bill Audit/Review Co. Genex Chestnut St. Philadelphia PA /26/07 Indefinite Fedex Ground Package System Inc Bill Audit/Review Co. Genex Fidelity & Deposit Company of Maryl TPA Zurich Services Red Brook Blvd Owings Mills MD /19/02 Indefinite Firemens Insurance Co. of WA, D.C. TPA FA Richards PO Box Irving TX /06/03 Indefinite 3051 Ira E Woods Grapevine Colleyville ISD TPA JI Specialty Ave. Grapevine TX /01/08 Indefinite Great American Insurance Company TPA FA Richards PO Box 5432 Cincinnati OH /06/03 Indefinite 2525 Holly Hall, Harris County Hospital District TPA JI Specialty #100 Houston TX /01/10 Indefinite Harris Health System TPA JI Specialty Hartford Underwriters Insurance Co. TPA JI Specialty PO Box Austin TX /06/03 Indefinite Illinois National Insurance Company TPA FA Richards Capital Station, PO Box Austin TX /06/03 Indefinite Insurance Company of the State of PA TPA FA Richards PO Box Austin TX /06/03 Indefinite Keller ISD TPA JI Specialty Keller Parkway Keller TX /01/07 Indefinite La Marque ISD TPA JI Specialty Bayou Road La Marque TX /01/09 Indefinite Lion Insurance Co. TPA FA Richards US Highway 19 Holiday FL /06/03 Indefinite Livingston Independent School District TPA FA Richards PO Box 1297 Livingston TX /06/03 Indefinite Lockheed Martin Bill Audit/Review Co. Genex Chestnut St. Philadelphia PA /26/07 Indefinite 3700 Lake Austin Lower Colorado River Authority TPA JI Specialty Blvd Austin TX /01/06 Indefinite Maryland Casualty Company TPA Zurich Services Red Brook Blvd Owings Mills MD /19/02 Indefinite Merit Drive, Maryland Insurance Co TPA Zurich Services Suit 700 Dallas TX /19/02 Indefinite Mesquite Independent School District Bill Audit/Review Co. Argus Services Midwest Employers Casualty Co. Direct Contract N Outer 40, Suite 300 Chesterfield MO /06/03 Indefinite Midwest Employers Casualty Co. TPA FA Richards N. Outer Forty Dr. Chesterfield MO /14/08 Indefinite National American Insurance Company TPA FA Richards PO Box 38 Chandler OK /06/03 Indefinite 4/4/ of 4

6 PBM: Healthcare Solutions, Inc Meadow Church Rd., Suite 300 Duluth, GA (Direct, TPA, Other) (TPA name, if not direct) National Standard; merged into Maryland Casualty TPA Zurich Services American Lane Schaumburg IL /19/02 Indefinite National Union Fire Insurance Compa TPA FA Richards PO Austin TX /06/03 Indefinite New Hampshire Insurance Company TPA FA Richards PO Box Austin TX /06/03 Indefinite Boyer Blvd, North American Specialty Services TPA JI Specialty Suite 100 Austin TX /01/06 Indefinite North Forest Independent School District TPA Argus Services Su Dallas TX /01/09 Indefinite North River Insurance Co of New Jersey TPA FA Richards International PkPlano TX /06/03 Indefinite One Liberty Plaza Northern Insurance Company of NY TPA Zurich Services Broadway New York NY /19/02 Indefinite Northwest Independent School District TPA JI Specialty Texan Drive Justin TX /20/12 Indefinite Old Republic Risk Management TPA FA Richards PO Box Austin TX /06/03 Indefinite 115 Wild Basin Pacific Employers Ins. Co TPA FA Richards Road, Suite 207 Austin TX /06/03 Indefinite PMA Pennsylvania Manufacturer s Associated Ins Co TPA FA Richards Sentry Pkwy Blue Bell PA /06/03 Indefinite Richardson Independent School District Direct Contract South Greenville Richardson TX /09/04 Indefinite Rio Grande City CISD TPA JI Specialty Fort Ringgold Rio Grande City TX /01/09 Indefinite Safety National Casualty Direct Contract Schuetz Road St. Louis MO /28/09 Indefinite 2043 Woodland Safety National Casualty Corp TPA FA Richards Pkwy St. Louis MO /06/03 Indefinite Selective Insurance TPA Mitchell Willow Creek Road San Diego CA /04/04 Indefinite Sherwin Williams Bill Audit/Review Co. Genex East Swedesford Rd. Wayne PA /09/12 Indefinite South San Antonio ISD TPA JI Specialty Ray Ellison Blvd San Antonio TX /01/11 Indefinite Spring ISD TPA JI Specialty Ella Blvd. Spring TX /01/09 Indefinite 1501 S Mopac St. Paul Fire and Marine Insurace Co. TPA FA Richards Expressway Austin TX /06/03 Indefinite Starbucks Bill Audit/Review Co. Genex Chestnut St. Philadelphia PA /26/07 Indefinite 300 W 15th Street, State Office of Risk Management Direct Contract th Floor Austin TX /11/09 Indefinite Target Corporation TPA Broadspire Nicollet Mall, TPS 2670 Minneapolis MN /01/13 Indefinite Tarrant County TPA JI Specialty E. Weatherford, Suite 300 Fort Worth TX /01/07 Indefinite Texas Cotton Ginners Trust TPA Azivent Spurling Road, Suite 210 Dallas TX /19/04 Indefinite Texas Council Risk Management Fund TPA JI Specialty Boyer Blvd, Su Austin TX /01/06 Indefinite 6210 Highway East Texas Mutual Insurance Company Direct Contract Austin TX /26/05 Indefinite Texas Schools Property Casualty Coop. TPA JI Specialty US Hwy 290 W, Suite 480 Austin TX /01/09 Indefinite Texas Water Conservation Association TPA JI Specialty Boyer Blvd, Su Austin TX /01/06 Indefinite TPCIGA for Lumbermans Mutual Casualty TPA FA Richards TPCIGA for Reliance Nat'l Insurance Co TPA FA Richards Burnet Road Austin TX /06/03 Indefinite 4/4/ of 4

7 PBM: Healthcare Solutions, Inc Meadow Church Rd., Suite 300 Duluth, GA (Direct, TPA, Other) (TPA name, if not direct) Travis County Bill Audit/Review Co. Forte, Inc Chevy Chase Dr, Suite 400 Austin TX /12/02 Indefinite Trinity Mother Frances Health System TPA JI Specialty E. Dawson Tyler TX /01/06 Indefinite Twin City Fire Insurance Company TPA FA Richards One Hartford Plaza Hartford CT 12/09/11 Indefinite 9889 Willow Creek Tyson Foods Bill Audit/Review Co. Mitchell Road San Diego CA /04/04 Indefinite Union Insurance Company TPA FA Richards PO Box Dallas TX /06/03 Indefinite Union Insurance Company of Povidcent Direct Contract PO Box Richardson TX /3/2006 Indefinite Universal Underwriters Ins Co TPA Zurich Services College Blvd Overland Park KS /19/02 Indefinite 6900 North Dallas Universal Underwriters of TX TPA Zurich Services Parkway Plano TX /19/02 Indefinite University Health Systems TPA Argus Services Utica National Insurance Co of Texas Bill Audit/Review Co. Genex Chestnut St. Philadelphia PA /26/07 Indefinite Valiant Insurance Company TPA Zurich Services American Lane Schaumburg IL /19/02 Indefinite 1420 W Mockingbird Wesco Insurance Company TPA FA Richards Ln Dallas TX /06/03 Indefinite West Oso Independent School District TPA FA Richards Rockford Drive Corpus Christi TX /06/03 Indefinite 5200 Metcalf Westport Insurance Corp TPA FA Richards Avenue Overland Park KS /06/03 Indefinite Zurich American Insurance Company TPA FA Richards American Lane Schaumburg IL /06/03 Indefinite Zurich American Insurance Company TPA Zurich Services American Lane Schaumburg IL /19/02 Indefinite Zurich American Insurance Company of IL TPA Zurich Services American Lane Schaumburg IL /19/02 Indefinite For more information regarding pharmacy informal networks click on the link: bin/broker.exe?_service=wcext&_program=progext.pharm_networkrpt.sas 4/4/ of 4

8 PBM: Modern Medical, Inc Graphics Way Lewis Center, OH Main Phone (Direct, TPA, Other) (TPA name, if not direct) (Carrier) Street City State ZipCode Start Date End Date American Electric Power TPA Azivent Hopewell Drive Heath OH /5/2011 Per Notification Bexar County TPA Tristar Dolorosa San Antonio TX /5/2011 Per Notification Carolina Casualty Insurance Co TPA York Risk Mgmt Touchton Rd E Jacksonville FL /1/2013 Per Notification City of Irving TPA Tristar PO Box Irving TX /1/ /1/ City of North Richland Hills TPA AS&G NE Loop 820 North Richland Hills TX /8/2011 Per Notification City Of San Antonio TPA Sedgwick and Tristar Soledad San Antonio TX /1/ /1/ City of Waco Direct Direct P.O.Box 2570 Waco TX /1/ /1/ Collin County TPA Tristar Bloomdale Rd Mckinney TX /5/2011 Per Notification Fort Worth Independent School District TPA Tristar N University Dr. Fort Worth TX /5/2011 Per Notification Indiana Lumbermens Mutual Insurance Direct Direct Woodtrace View Indianapolis IN /5/2011 7/26/ Irving Independent School District Direct Direct W. Airport Fwy Irving TX /12/2013 Per Notification Judson Independent School District TPA Tristar Shin Oak Drive Live Oak TX /5/2011 Per Notification Midwest Employers Casualty Co TPA York Risk Mgmt N Outer Rd Chesterfield MO /1/2013 Per Notification Port of Houston Authority TPA AS&G East Loop North Houston TX /8/2011 Per Notification San Antonio Independent School District TPA Tristar Lavaca San Antonio TX /5/2011 Per Notification Starnet Insurance Co TPA York Risk Mgmt Marblestone Dr Woodbridge VA /1/2013 Per Notification State Auto Property & Casualty Co Other N. Meridian Street Indianapolis IN /5/2011 Per Notification Texas Hospital Insurance Exchange Direct Direct N. Capital of Texas H Austin TX /5/2011 Per Notification TPS Joint Self Insurance Fund Other N Dallas Parkway Dallas TX /5/2011 Per Notification Valero Energy Corp Other PO Box San Antonio TX /18/2012 Per Notification Via Metropolitan Transit Workers' Comp Other San Pedro San Antonio TX /5/2011 Per Notification For more information regarding pharmacy informal networks click on the link: bin/broker.exe?_service=wcext&_program=progext.pharm_networkrpt.sas 4/4/ of 1

9 PBM: Healthesystems 5100 W. Lemon St. Tampa, FL TX Carrier Listing 1st Qtr 2018 Network: Optum RX 1600 McConnor Parkway Schaumbug, IL (direct, thru TPA, Other) (TPA name, if not direct) Accident Fund General Insurance Company Direct Contract Accident Fund General Insurance Company Other Paradigm PO Box Lansing MI Accident Fund Insurance Co of America Other Paradigm PO Box Lansing MI Ace American Insurance Co Third Party Administrator Constitution State Services W. Lemon Street #207 Tampa FL Ace American Insurance Co Other Paradigm W. Lemon Street #207 Tampa FL Ace Fire Underwriters Ins Co Third Party Administrator Constitution State Services Walnut Street Philadelphia PA Ace Property & Casualty Ins Co Third Party Administrator Constitution State Services Walnut Street Philadelphia PA ACIG Insurance Co Other Paradigm N. Central Expy Suite 800 Richardson TX /7/ AIG Assurance Co Third Party Administrator Constitution State Services Water Street NY NY AIG Property Casualty Co Third Party Administrator Constitution State Services Water Street NY NY AIU Insurance Co Third Party Administrator Constitution State Services Water Street 24th Floor NY NY Allmerica Financial Benefit Insurance Company Other Paradigm Lincoln Street Worcester MA American Casualty Co of Reading PA Other Paradigm S Wabash Avenue Chicago IL /7/ American Guarantee & Liability Ins Co Third Party Administrator Constitution State Services American Ln Schaumburg IL American Guarantee & Liability Ins Co Other Paradigm American Ln Schaumburg IL American Home Assurance Co Third Party Administrator Constitution State Services Water Street NY NY American Interstate Insurance Co Direct Contract Hwy 190 West DeRidder LA American Interstate Insurance Co of Texas Direct Contract Hwy 190 West DeRidder LA American Zurich Insurance Co Third Party Administrator Constitution State Services American Lane Tower2, Fl 5 Schaumburg IL American Zurich Insurance Co Other Paradigm American Lane Tower2, Fl 5 Schaumburg IL Amerisure Insurance Co Other Paradigm Bay Center Dr. #200 Tampa FL Amerisure Mutual Insurance Co Direct Contract Bay Center Dr. #200 Tampa FL Amerisure Mutual Insurance Co Other Paradigm Bay Center Dr. #200 Tampa FL Amerisure Mutual Insurance Co Other Paradigm Bay Center Dr. #200 Tampa FL Assurance Co of America Third Party Administrator Constitution State Services Keswick Rd. Baltimore MD Assurance Co of America Other Paradigm Keswick Rd. Baltimore MD Atlantic Specialty Ins Co Other Paradgim Highway, 169 North, Suite 800 Phymouth MN Automobile Ins Co of Hartford Cn Direct Contract Travelers One Tower Square Hartford CT Bankers Standard Fire & Marine Co Third Party Administrator Constitution State Services Walnut Street Philadelphia PA Bankers Standard Ins Co Third Party Administrator Constitution State Services Walnut Street Philadelphia PA Castlepoint National Insurance Co Other Paradigm South Riverside Plaza Chicago IL Century Indemnity Co Third Party Administrator Constitution State Services South 17th Street, Suite 1810 Philadelphia PA Charter Oak Fire Insurance Co Direct Contract Travelers Tower Sq. Hartford CT Charter Oak Fire Insurance Co Other Paradgim Tower Sq. Hartford CT Colonial American Casualty & Surety Co Third Party Administrator Constitution State Services E. Cherry Lane Souderton PA Commerce & Industry Insurance Co Third Party Administrator Constitution State Services Main Street Webster MA Discover Property & Casualty Insurance Co Direct Contract Travelers 385 Washington Street Saint Paul MN Eastguard Insurance Co Direct Contract S River Street Wilkes Barre PA Employers Assurance Co Other Paradigm US Highway One Suite 300 North Palm Beach CA Everest National Insurance Co Other Paradigm Martinsville Road Liberty Corner NJ Farmington Casualty Co Direct Contract Travelers One Tower Square Hartford CT Fcci Insurance Company Direct Contract Fcci Univeritsy Parkway Sarasota FL Fidelity & Deposit Co of Maryland Third Party Administrator Constitution State Services Red Brook Blvd Owing Mills MD Fidelity & Guaranty Ins Underwriters Inc Direct Contract Travelers Washington Street Saint Paul MN Fidelity & Guaranty Insurance Co Direct Contract Travelers Washington Street Saint Paul MN Fidelity & Guaranty Insurance Co Third Party Administrator Sentry Washington Street Saint Paul MN Fidelity & Guaranty Insurance Co Third Party Administrator Sentry Insurance Washington Street Saint Paul MN Firemans Fund Insurance Co Other Paradigm W. Washting Street Chicago IL Florists Mutual Insurance Co Direct Contract Sentry #1 Horticultural Lane Edwardsville IL Granite State Insurance Co Third Party Administrator Constitution State Services N Main Street Granite Falls NC Hanover American Ins Co Other Paradigm Lincoln Street Worcester MA Illinois National Insurance Co Third Party Administrator Constitution State Services 300 South Riverside Plaza Chicago IL /4/ of 3

10 PBM: Healthesystems 5100 W. Lemon St. Tampa, FL TX Carrier Listing 1st Qtr 2018 Network: Optum RX 1600 McConnor Parkway Schaumbug, IL (direct, thru TPA, Other) (TPA name, if not direct) Illinois National Insurance Co Other Paradigm 300 South Riverside Plaza Chicago IL Imperium Insurance Co Other Paradigm Gessner Rd #600 Houston TX Indemnity Insurance Co of North America Third Party Administrator Constitution State Services Walnut Street Philadelphia PA Indemnity Insurance Co of North America Other Paradigm Walnut Street Philadelphia PA Insurance Co of North America Third Party Administrator Constitution State Services Walnut Street Philadelphia PA Insurance Co of the State of PA Third Party Administrator Constitution State Services Pine Street NY NY Kimberly Clark Corp Third Party Administrator Sentry 351 Phelps Drive Irving TX Maryland Casualty Co Third Party Administrator Constitution State Services Amican Lane Tower 1 Schaumburg IL Meridian Security Insurance Co Direct Contract N. Meridian St. Indianapolis IN Meridian Security Insurance Co Other Paradigm N. Meridian St. Indianapolis IN Middlesex Insurance Co Direct Contract Sentry N. Point Drive Stevens Point WI Monroe Guaranty Insurance Company Direct Contract Fcci N. Meridian St Carmel IN National Fire Insurance Co of Hartford Other Paradigm S Wabash Avenue Chicago IL /7/ National Interstate Insurance Co Other Paradigm Interstate Drive Richfield OH National Surety Corp Other Paradigm 777 San Marin Drive Novato CA National Trust Insurance Company Direct Contract Fcci S Gay Street Baltimore MD National Union Fire Ins Co of Pittsb PA Direct Contract Water Street 18th Floor NY NY National Union Fire Ins Co of Pittsb PA Other Constitution State Services Water Street 18th Floor NY NY National Union Fire Ins Co of Pittsb PA Other Paradigm Water Street 18th Floor NY NY New Hampshire Insurance Co Third Party Administrator Constitution State Services Pine Street NY NY New Hampshire Insurance Co Other Paradigm Pine Street NY NY Nipponkoa Insurance Co Limited US Direct Contract Travelers Wall Street 8th Floor NY NY Northern Insurance Co of New York Third Party Administrator Constitution State Services American Lane Tower2, Fl 5 Schaumburg IL Old Republic General Insurance Corp Other Paradigm North Michigan Ave Chicago IL Old Republic Insurance Co Other Paradigm North Michigan Ave Chicago IL Pacific Employers Insurance Co Third Party Administrator Constitution State Services Walnut Street Philadelphia PA Parker Hannifin Corp Direct Contract Parkland Blvd Cleveland OH Patriot General Insurance Company Direct Contract Sentry N. Point Drive Stevens Point WI Phoenix Insurance Co Direct Contract One Tower Square Hartford CT Phoenix Insurance Co Direct Contract Travelers One Tower Square Hartford CT PPG Industries Inc Third Party Administrator Sentry One PPG Place Pittsburgh PA Praetorian Insurance Co Other Paradigm One General Drive Sun Prarie WI Select Insurance Co Direct Contract Travelers 6300 Wilson Mills Road Mayfield Village OH Sentry Casualty Co Direct Contract N. Point Drive Stevens Point WI Sentry Insurance A Mutual Co Direct Contract N. Point Drive Stevens Point WI Sentry Select Insurance Co Direct Contract N. Point Drive Stevens Point WI St Paul Fire & Marine Insurance Co Direct Contract Travelers One Tower Square Hartford CT St Paul Guardian Insurance Co Direct Contract Travelers Washington Street Saint Paul MN St Paul Mercury Insurance Direct Contract Travelers Washington Street Saint Paul MN St Paul Protective Insurance Co Direct Contract Travelers Washington Street Saint Paul MN Standard Fire Insurance Co Direct Contract Travelers One Tower Square Hartford CT Standard Fire Insurance Co Other Paradigm One Tower Square Hartford CT TPCIGA for Lumbermens Underwriting Alliance Other Paradigm N.W. Corprate Blvd Baca Raton FL Travelers Casualty & Surety Co Direct Contract Travelers One Tower Square Hartford CT Travelers Casualty & Surety Co Other Paradigm One Tower Square Hartford CT Travelers Casualty & Surety Co of America Direct Contract Travelers One Tower Square Hartford CT Travelers Casualty Co Direct Contract Travelers One Tower Square Hartford CT Travelers Casualty Co of Connecticut Direct Contract Travelers One Tower Square Hartford CT Travelers Casualty Ins Co of America Direct Contract Travelers One Tower Square Hartford CT Travelers Commercial Casualty Direct Contract Travelers One Tower Square Hartford CT Travelers Commercial Insuranc Co Direct Contract Travelers One Tower Square Hartford CT Travelers Constitution State Insurance Co One Tower Square Hartford CT /4/ of 3

11 PBM: Healthesystems 5100 W. Lemon St. Tampa, FL TX Carrier Listing 1st Qtr 2018 Network: Optum RX 1600 McConnor Parkway Schaumbug, IL (direct, thru TPA, Other) (TPA name, if not direct) Travelers Indemnity Co Direct Contract Travelers One Tower Square Hartford CT Travelers Indemnity Co Other Paradigm One Tower Square Hartford CT Travelers Indemnity Co of America Direct Contract Travelers One Tower Square Hartford CT Travelers Indemnity Co of Connecticut Direct Contract Travelers One Tower Square Hartford CT Travelers Indemnity Co of Connecticut Other Paradigm One Tower Square Hartford CT Travelers Lloyds Ins Co Direct Contract Travelers One Tower Square Hartford CT Travelers Lloyds of Tx Ins Co Direct Contract Travelers One Tower Square Hartford CT Travelers Property Casualty Company of America Direct Contract Travelers One Tower Square Hartford CT United States Fidelity & Guaranty Co Direct Contract Travelers Washington Street Saint Paul MN United States Fire Insurance Co Other Paradigm Madison Ave Morristown NJ Universal Underwriters Insurance Co Third Party Administrator Constitution State Services College Boulevard Overland Park KS Universal Underwriters of Tx Ins Co Third Party Administrator Constitution State Services Zurich Way Schaumburg IL Westchester Fire Insurance Co Third Party Administrator Constitution State Services Walnut Street Philadelphia PA Westfield Insurance Co Direct Contract Westfield Insurance Co Park Circle Westfield Center OH Zurich American Ins Co of Illinois Third Party Administrator Constitution State Services American Lane Schaumburg IL Zurich American Ins Co of Illinois Other Paradigm American Lane Schaumburg IL Zurich American Insurance Co Third Party Administrator Constitution State Services American Lane Schaumburg IL Zurich American Insurance Co Other Paradigm American Lane Schaumburg IL For more information regarding pharmacy informal networks click on the link: bin/broker.exe?_service=wcext&_program=progext.pharm_networkrpt.sas 4/4/ of 3